M. B. Richardson1, R. J. Reif1, S. Haruna1, H. Jensen1, S. Karim1, W. C. Beck1, J. R. Taylor1, K. W. Sexton1 1University of Arkansas for Medical Sciences,Little Rock, AR, USA
Introduction: Small bowel obstruction (SBO) is common in patients hospitalized for acute abdominal pain. However, data on long-term follow-up of patients is lacking and no superior management strategy has been identified. We hypothesized that surgical management would decrease readmissions compared to medical management in the treatment of SBO.?
Methods: This was a retrospective study of the 2010 – 2014 National Readmissions Database. Patients diagnosed with SBO were categorized into two groups: patients that were operatively treated (surgical), and patients managed conservatively (medical). We compared the in-hospital outcomes and readmission rates between the two groups (α=0.05). ?
Results: Within the study period, 778,599 patients diagnosed with SBO were identified. A total of 68,400 (8.8%) patients were treated surgically, compared to 710,199 (91.2%) patients in the medical group. Overall mortality (7.7% vs 4.4%, p<0.01) and length of stay (15.7 vs 7.3 days, p<0.01) were higher in surgically treated patients. However, while 83,007 (11.7%) of the patients treated medically were readmitted, only 4,795 (7.0%) of the patients treated surgically necessitated readmission to the hospital. Cost of care was higher for surgically treated patients both during initial hospital stay ($155,293 vs $67,918, p<0.01) and at readmission ($269,105 vs $123,334, p<0.01).?
Conclusion: Surgical treatment of SBO was associated with higher in-hospital mortality and longer length of stay. Patients who were treated medically for SBO had significantly higher readmission rates. Despite a higher rate of readmission, conservative treatment was associated with lower cost of care both at initial hospital admission and readmission. Non-operative management of SBO is a viable and cost-effective treatment strategy.?