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Evolving Management Strategies in Patients with Adhesive Small Bowel Obstruction: a Population-Based Analysis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

In patients with adhesive small bowel obstruction (aSBO), the decision to operate as well as the timing and technique of surgery have significant impacts on clinical outcomes. Trends in the management of aSBO have not been described at the population level and guideline adherence is unknown. We sought to evaluate the secular trends in the management of aSBO in a large North American population.

Methods

We used administrative data to identify patients admitted to hospital for their first episode of aSBO over 2005–2014. We evaluated temporal trends in admission for aSBO and in management practices using Cochran-Armitage tests. Multivariable logistic regressions were used to assess trends when controlling for potential confounders.

Results

Patients (40,800) were admitted with their first episode of aSBO. The mean age was 68.5 years and 55% of patients were female. The population-based rate of admission for aSBO decreased over the study period, from 39.1 to 38.1 per 100,000 persons per year. There was a significant increase in the proportion of patients who underwent surgery for aSBO (19 to 23%, p < 0.0001). Among those who underwent surgery, there were significant increases in the proportions of patients who underwent laparoscopic procedures (4 to 14%, p < 0.0001) and who underwent surgery within 1 day of admission (51 to 60%, p < 0.0001).

Conclusion

Between 2005 and 2014, there was a decrease in the population-based rate of aSBO, which may reflect increased utilization of minimally invasive techniques. There were significant trends towards increased operative intervention, with surgery occurring earlier and increasingly using laparoscopic approach.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada

    Ramy Behman, Avery B. Nathens, Nicole Look Hong & Paul J Karanicolas

  2. Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, T2-016, Toronto, ON, M4N 3M5, Canada

    Avery B. Nathens, Nicole Look Hong & Paul J Karanicolas

  3. Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada

    Avery B. Nathens, Nicole Look Hong, Petros Pechlivanoglou & Paul J Karanicolas

  4. Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada

    Petros Pechlivanoglou

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  1. Ramy Behman
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Contributions

Study conception and design: Behman, Nathens, Karanicolas.

Acquisition of data: Behman, Nathens, Karanicolas.

Analysis and interpretation of data: Behman, Nathens, Pechlivanoglou, Karanicolas.

Drafting of manuscript: Behman, Nathens, Look Hong, Karanicolas.

Critical revision: Nathens, Look Hong, Pechlivanoglou, Karanicolas.

Corresponding author

Correspondence to Paul J Karanicolas.

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Disclaimer

The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.

Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the author, and not necessarily those of CIHI.

Sources of Support

Physician Services Incorporated Resident Research Grant, Ministry of Health and Long-term Care Clinician Investigator Program, Canadian Institute of Health Research New Investigator Award, Canada Research Chair for Systems in Trauma Care.

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Behman, R., Nathens, A.B., Look Hong, N. et al. Evolving Management Strategies in Patients with Adhesive Small Bowel Obstruction: a Population-Based Analysis. J Gastrointest Surg 22, 2133–2141 (2018). https://doi.org/10.1007/s11605-018-3881-z

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  • DOI: https://doi.org/10.1007/s11605-018-3881-z

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