Should we let the sun set or rise on a small bowel obstruction: mortality and readmission rates in operative versus nonoperative management

Abstract

Background: Recurrent small bowel obstruction (SBO) can result in significant morbidity and mortality. In this study, we aimed to compare readmission and its impact on operatively and nonoperatively managed patients admitted with SBO.

Methods: We performed a retrospective analysis using the National Readmission Database 2016-2017 and included all patients (≥ 18y) who were non-elective admissions for SBO during the index hospitalization. Patients were dichotomized into two groups: Operative group (OM) and nonoperative group (NOM). Primary outcomes included rates of readmission and mortality upon readmission. Secondary outcomes included complications, which were defined as fistula, abscess, perforation, peritonitis, and sepsis.

Results: 122,778 patients admitted for SBO were included. Overall, the readmission was 29.8%, with 34.4% readmitted within 30 days. 6.4% were OM, while 93.6% were NOM during index admission. Among OM patients, the readmission rate was significantly lower at 28.6% compared to NOM at 29.9% (p < 0.001). Among the readmitted NOM patients, 88.3% had emergency readmissions, with 10.6% requiring operative intervention. Adjusted analyses revealed that NOM had 32% higher odds of readmission (p < 0.001). Other factors increasing the odds of readmission included female sex, a high Charlson comorbidity index, and an admission diagnosis of cancer. Among readmitted patients, NOM had 50% higher odds of mortality during readmission. Each readmission raised the odds of mortality by 4.0% (p < 0.001). Operative management in the first readmission was associated with younger age, private insurance status, and non-operative management during the index admission.

Conclusion: While cost, length of stay, and complications were higher in OM, NOM was associated with a higher readmission rate and mortality upon readmission. Each additional readmission for small bowel obstruction increased the odds of mortality by 4.0%.

Keywords: Adhesions; Mortality; Nonoperative; Operative; Readmission; Small bowel obstruction.