Original scientific article
Small Bowel Obstruction: A Population-Based Appraisal

Presented at the American College of Surgeons 91st Annual Clinical Congress, San Francisco, CA, October 2005.
https://doi.org/10.1016/j.jamcollsurg.2006.04.020Get rights and content

Background

Small bowel obstruction (SBO) is a common reason for surgical consultation, but little is known about the natural history of SBO. We performed a population-based analysis to evaluate SBO frequency, type of operation, and longterm outcomes.

Study design

Using the California Inpatient File, we identified all patients admitted in 1997 with a diagnosis of SBO. Patients were excluded if they had a diagnosis of bowel obstruction in the previous 6 years (1991 to 1996). Of the remaining cohort, the natural history of SBO over the subsequent 5 years (1998 to 2002) was analyzed. Index hospitalization outcomes (eg, surgical versus nonsurgical management, length of stay, in-hospital mortality), and longterm outcomes, including SBO readmissions and 1-year mortality, were evaluated.

Results

We identified 32,583 patients with an index admission for SBO in 1997; 24% had surgery during the index admission. The distribution of surgical procedures was: 38% lysis of adhesions, 38% hernia repair, 18% small bowel resection with lysis of adhesions, and 6% small bowel resection with hernia repair. Patients who underwent operations during index admission had longer lengths of stay, lower mortality, fewer SBO readmissions, and longer time to readmission than patients treated nonsurgically. Regardless of treatment during the index admission, 81% of surviving patients had no additional SBO readmissions over the subsequent 5 years.

Conclusions

Most of the 32,583 patients requiring admission for index SBO in 1997 were treated nonsurgically, and few of these patients were readmitted. This is the first longitudinal population-based analysis of SBO evaluating surgical versus nonsurgical management and outcomes, including mortality and readmissions.

Section snippets

Data source

Hospitalization data were obtained from California’s Office of Statewide Health Planning and Development (OSHPD),7 in Sacramento, CA, which collects annual data from all inpatients discharged from acute care hospitals licensed by the state of California. Each discharge abstract in the Patient Discharge Database (PDD) contains a unique record linkage number (eg, encrypted social security number), demographic data (eg, age, gender, race or ethnicity, type of insurance, ZIP code of residence),

Patient demographics

There were 45,770 patients with a diagnosis of bowel obstruction admitted to hospitals in the state of California in 1997. Based on the exclusion criteria of a scheduled admission and presence of a large bowel resection or anastomosis, 32,583 patients were identified for additional analysis as outlined in Figure 1. All of these admissions were unscheduled, and 71% were admitted through the emergency room. The average age was 63 years and 43% had no medical comorbidities, as measured by the

Discussion

Small bowel obstruction, and in particular, SBO secondary to adhesions formed after earlier abdominal operation, presents a problem of staggering magnitude in developed countries. In this study, during the year 1997 in the state of California, SBO accounted for 32,583 unscheduled admissions, and approximately 85% were secondary to adhesions. To put this number in perspective, during 1997, there were 9,675 colon resections for colon cancer.7 In a large, multiinstitutional, retrospective cohort

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Competing Interests Declared: None.

Grant support: UCLA Robert Wood Johnson Clinical Scholars Program (McGory).

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