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. 2021 Feb;25(2):512-522.
doi: 10.1007/s11605-019-04496-3. Epub 2020 Feb 10.

Re-examining "Never Letting the Sun Rise or Set on a Bowel Obstruction" in the Era of Acute Care Surgery

Adrian Diaz  1   2 , Kevin B Ricci  1   2 , Amy P Rushing  1   2 , Angela M Ingraham  3 , Vijaya T Daniel  4 , Anghela Z Paredes  1   2 , Holly E Baselice  1   2 , Wendelyn M Oslock  2   5 , Victor Heh  1   2 , Scott A Strassels  1   2 , Heena P Santry  6   7
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Re-examining "Never Letting the Sun Rise or Set on a Bowel Obstruction" in the Era of Acute Care Surgery

Adrian Diaz et al. J Gastrointest Surg. 2021 Feb.

Abstract

Background: Small bowel obstruction (SBO) no longer mandates urgent surgical evaluation raising the question of the role of operating room (OR) access on SBO outcomes.

Methods: Data from our 2015 survey on emergency general surgery (EGS) practices, including queries on OR availability and surgical staffing, were anonymously linked to adult SBO patient data from 17 Statewide Inpatient Databases (SIDs). Univariate and multivariable associations between OR access and timing of operation, complications, length of stay (LOS), and in-hospital mortality were measured.

Results: Of 32,422 SBO patients, 83% were treated non-operatively. Operative patients were older (median 66 vs 65 years), had more comorbidities (53% vs 46% with ≥ 3), and experienced more systemic complications (36% vs 23%), higher mortality (2.8% vs 1.4%), and longer LOS (median 10 vs 4 days). Patients had lower odds of operation if treated at hospitals lacking processes to tier urgent cases (aOR 0.90, 95% CI [0.83-0.99]) and defer elective cases (aOR 0.87 [0.80-0.94]). Patients had higher odds of operation if treated at hospitals with surgeons sometimes (aOR 1.14 [1.04-1.26]) or rarely/never (aOR 1.16 [1.06-1.26]) covering EGS at more than one location compared to always. Odds of systemic complication (OR 2.0 [1.6-2.4]), operative complication (OR 1.5 [1.2-1.8]), and mortality were increased for very late versus early operation (OR 2.6 [1.7-4.0]).

Conclusions: Although few patients with SBO require emergency surgery, we identified EGS structures and processes that are important for providing timely and appropriate intervention for patients whose SBO remains unresolved and requires surgery.

Keywords: Emergency general surgery; mortality; small bowel obstruction; survey; workforce.

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Conflict of interest statement

Conflict of Interest Dr. Santry is a paid consultant by the Johnson & Johnson Company on a fragility fracture advisory board. The submitted work is not related to this topic.

Figures

Figure. 1
Figure. 1
Odds of any major systemic complication, any major operative complication, and mortality by timing of operation for patients treated for small bowel obstruction
See this image and copyright information in PMC

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