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

  • Original Article
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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

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.

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Availability of data and material

Data are published by the California Office of Statewide Health Planning and Development.

Code availability

Stata statistical software analysis code available upon request.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Trauma Service (MER62), Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA

    Matthew J. Carr, Jayraan Badiee, Derek A. Benham, Joseph A. Diaz, Richard Y. Calvo, Carol B. Sise, Matthew J. Martin & Vishal Bansal

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  1. Matthew J. Carr
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  2. Jayraan Badiee
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  3. Derek A. Benham
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  4. Joseph A. Diaz
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  8. Vishal Bansal
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Contributions

MJC conducted the literature search. MJC, JB, DAB, JAD, RYC, CBS, MJM, and VB participated in the conception or design of the work. MJC, JB, and RYC acquired, analyzed, or interpreted the data for the work. MJC, JB, DAB, JAD, RYC, CBS, MJM, and VB participated in drafting the work or revising it for important intellectual content. All authors approved the final version of the work to be published.

Corresponding author

Correspondence to Matthew J. Martin.

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Conflicts of interest

The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article. The authors report no conflict of interest.

Ethics approval

This study was approved by the California Health and Human Services Agency Committee for the Protection of Human Subjects and the local Institutional Review Board.

Consent to participate

Requirement of informed consent was waived for this study by the institutions listed in the Ethics Approval section.

Additional information

Meeting Presentation: This work was presented as a poster presentation at the 79th Annual Meeting of the American Association for the Surgery of Trauma and Clinical Congress of Acute Care Surgery, September 8–18, 2020. Virtual Meeting.

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Carr, M.J., Badiee, J., Benham, D.A. et al. Surgical management and outcomes of adhesive small bowel obstruction: teaching versus non-teaching hospitals. Eur J Trauma Emerg Surg 48, 107–112 (2022). https://doi.org/10.1007/s00068-021-01812-y

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  • DOI: https://doi.org/10.1007/s00068-021-01812-y

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