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Management of adhesive small bowel obstruction

A distinct paradigm shift in the United States

Matsushima, Kazuhide, MD; Sabour, Andrew, BS; Park, Caroline, MD, MPH; Strumwasser, Aaron, MD; Inaba, Kenji, MD; Demetriades, Demetrios, MD, PhD

Journal of Trauma and Acute Care Surgery: March 2019 - Volume 86 - Issue 3 - p 383–391
doi: 10.1097/TA.0000000000002150
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BACKGROUND Recent studies show that early operative intervention in patients who fail nonoperative management of adhesive small bowel obstruction (ASBO) is associated with improved outcomes. The purpose of this study was to determine the trend in practice pattern and outcomes of patients with ASBO in the United States.

METHODS Data from the National Inpatient Sample data (2003–2013) were extracted for analysis and included patients (age ≥18 years) who were discharged with primary diagnosis codes consistent with ASBO. We analyzed the data to examine changes in mortality and hospital length of stay in addition to any trends in rate and timing of operative interventions.

RESULTS During the study period, 1,930,289 patients were identified with the diagnosis of ASBO. Over the course of the study period, the rate of operative intervention declined (46.10–42.07%, p = 0.003), and the timing between admission and operative intervention was significantly shortened (3.09–2.49 days, p < 0.001). In addition, in-hospital mortality rate decreased significantly (5.29–3.77%, p < 0.001). In the multiple logistic regression analysis, the relative risk of mortality decreased by 5.6% per year (odds ratio, 0.944; 95% confidence interval, 0.937–0.951; p < 0.001). Hospital length of stay decreased from 10.39 to 9.06 days (p < 0.001).

CONCLUSION Over the last decade, fewer patients with ASBO were managed operatively, whereas those requiring an operation underwent one earlier in their hospitalization. Although further studies are warranted, our results suggest that recent changes in practice pattern may have contributed to improved outcomes.

LEVEL OF EVIDENCE Therapeutic study, level IV.

From the Division of Acute Care Surgery (K.M., A.S., C.P., A.S., K.I., D.D.), University of Southern California, Los Angeles, California.

Submitted: September 7, 2018, Revised: November 2, 2018, Accepted: November 9, 2018, Published online: November 28, 2018.

This study was presented at the 77th Annual Meeting of the American Association for Surgery of Trauma and Clinical Congress of Acute Care Surgery, September 26, 2018, in San Diego, California.

Address for reprints: Kazuhide Matsushima, MD, Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, 2051 Marengo St, Inpatient Tower (C), C5L100, Los Angeles, CA 90033; email:

© 2019 Lippincott Williams & Wilkins, Inc.