Surgical intervention for adhesive small bowel obstruction associated with decreased risk of recurrence

Reference

Behman R, Nathens AB, Mason S, et al. Association of surgical intervention for adhesive small-bowel obstruction with risk of recurrence. JAMA Surg 2019 Jan 30. doi: 10.1001/jamasurg.2018.5248. [Epub ahead of print]

Synopsis

Using 4 population-level administrative databases from Ontario, Canada, these investigators evaluated whether operative management of aSBO is associated with a reduced risk of recurrence of disease. Adult patients between the ages of 18 years to 80 years who were admitted to the hospital during a 10-year period with their first episode of aSBO were included in the study (N = 27,904). Of this cohort, 6186 (22.2%) underwent operative management during their index admission and the rest were treated nonoperatively. Patients treated operatively were younger (60.2 vs 61.5 years), more likely to be women (57.8% vs 49.2%), and were less likely to have a high or very high comorbidity burden (50.3% vs 60.7%). Using propensity scores, patients in the operative group were matched with patients in the nonoperative groups, resulting in 6160 patients in each group. Within this matched cohort, the primary outcome of recurrent aSBO was significantly lower in the group of patients who underwent operative management during their index admission (13.0% vs 21.3%; P < .001). For each episode of aSBO managed nonoperatively, the risk of recurrence increased, with a risk of 48% recurrence following a third episode. Additionally, operative management at any episode was associated with a lower risk of subsequent episodes.