Surgical management and outcomes of adhesive small bowel obstruction: teaching versus non-teaching hospitals

• Published in: European journal of trauma and emergency surgery (Munich : 2007) Vol. 48; no. 1; pp. 107 - 112
• Main Authors: Carr, Matthew J., Badiee, Jayraan, Benham, Derek A., Diaz, Joseph A., Calvo, Richard Y., Sise, Carol B., Martin, Matthew J., Bansal, Vishal
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2022; Springer Nature B.V
• Subjects: Adhesives; Adult; Colorectal surgery; Critical Care Medicine; Emergency medical care; Emergency Medicine; Humans; Intensive; Intestinal obstruction; Intestinal Obstruction - surgery; Intestine, Small - surgery; Medicine; Medicine & Public Health; Original Article; Retrospective Studies; Small intestine; Sports Medicine; Surgery; Surgical Orthopedics; Surgical outcomes; Tissue Adhesions; Traumatic Surgery; Treatment Outcome; Teaching hospital; Time to surgery; Management; Adhesive small bowel obstruction; Operative intervention
• ISSN: 1863-9933; 1863-9941
• DOI: 10.1007/s00068-021-01812-y

Background The relationship between surgical management of adhesive small bowel obstruction (ASBO) and hospital teaching status is not well known. We sought to elucidate the association between hospital teaching status and clinical metrics for ASBO. Methods Using the 2007–2017 California Office of Statewide Health Planning and Development database, we identified adult ASBO patients hospitalized for surgical intervention. Hospital teaching status was categorized as major teaching (MajT), minor teaching (MinT), and non-teaching (NT). Cox proportional hazards modeling was used to evaluate risk of death and other adverse outcomes. Results Of 25,047 admissions, 15.4% were at MajT, 32.0% at MinT, and 52.6% at NT; 2.9% died. Patients at MajT had longer overall hospital stays (HLOS) than those at MinT or NT (median days 9 vs. 8 vs. 8; p  = 0.005), longer post-ASBO procedure HLOS (median days 7 vs. 6 vs. 6; p  = 0.0001) and higher rates of small bowel resection (27.1% vs. 21.7% vs. 21.7%; p  < 0.0001). Mean time to first surgery at MajT was 3.3 days compared with 2.6 days ( p  = 0.004) at MinT and NT. Compared with patients at NT, those at MajT were significantly less likely to die (HR 0.62, p  < 0.0001), develop pneumonia (HR 0.57, p  = 0.001), or experience adverse discharge disposition (HR 0.79, p  < 0.0001). Conclusion Mortality and morbidity of ASBO surgery were reduced at MajT; however, time to surgery, HLOS, and rate of small bowel resection were greater. These findings may guide improvements in the management of ASBO patients.