J. L. Buicko1, J. Parreco1, M. A. Lopez1, R. Rattan1, M. A. Lopez-Viego1, R. A. Kozol1 1University Of Miami,Palm Beach General Surgery Residency,Atlantis, FL, USA
Introduction:
Most prior large population-based studies comparing laparoscopic and open surgery for adhesive small bowel obstruction have found more favorable outcomes with laparoscopic surgery. However, these studies were limited in comparison of readmission rates. The purpose of this study was to compare outcomes after surgery for adhesive small bowel obstruction including readmissions to different hospitals across the US.
Methods:
The Nationwide Readmission Database for 2013-2014 was queried for all patients aged 18 years or older with a primary diagnosis of small bowel obstruction and undergoing enterolysis. Patients with diagnoses related to non-adhesive causes of small bowel obstruction were excluded. Groups were created based on the type of surgery: open, laparoscopic, and laparoscopic converted to open. Outcomes of interest were: small bowel repair/resection, length of stay (LOS) > 7 days, in-hospital mortality, readmission within 30 days, and readmission within 30 days to a different hospital. Univariable logistic regression was performed for these outcomes and the variables with p<0.05 were used for multivariable logistic regression. Results were weighted for national estimates.
Results:
There were 65,283 patients who underwent operative treatment for adhesive small bowel obstruction. Open surgery was used to treat 83.2%, laparoscopic surgery alone was used in 13.4%, while 3.3% were laparoscopic converted to open. The laparoscopic approach was associated with reduced risk for small bowel resection or repair (OR 0.42, p<0.01). Laparoscopic converted to open was associated with an increased risk for small bowel resection or repair (OR 1.38, p<0.01). Risk of mortality was decreased with laparoscopic surgery (OR 0.52, p<0.01) and cases converted to open (OR 0.62, p=0.01). Risk for LOS >7 days was also decreased with laparoscopic surgery (OR 0.28, p<0.01) while there was no difference between open and converted cases (OR 1.05, p=0.39). Laparoscopic surgery was also associated with a decreased risk for readmission (OR 0.70, p<0.01) and there was no difference between open and converted cases (OR 1.08, p=0.30).
Conclusion:
Outcomes after surgery for adhesive small bowel obstruction, including readmission rates, are more favorable for laparoscopic surgery. Additionally, laparoscopic converted to open outcomes are similar to open alone.