Prompt intervention in large bowel obstruction management: A Nationwide Inpatient Sample analysis

Abstract

Background: Large bowel obstruction is an urgent condition which can progress to ischemia and perforation. The importance of prompt intervention has not been rigorously demonstrated.

Methods: Patients with bowel obstruction who underwent stoma, stent, and/or colectomy in the Nationwide Inpatient Sample were used to study prompt intervention (defined as occurring within 2 days of admission). Outcomes were inpatient mortality, discharge to home, and length of stay in an adjusted analysis.

Results: Among the 31,277 patients, prompt intervention occurred in 42.6%. In an adjusted analysis, prompt intervention was more likely in higher income patients and less likely in patients with comorbidities; among those with malignant obstruction, less likely in women, and among those with benign obstruction, less likely in Blacks. Inpatient mortality (6%) was not different between groups. Discharge home (71% vs 68%; p < 0.0001) and shorter LOS (-3 days) occurred in those managed promptly.

Conclusion: Prompt intervention in large bowel obstruction results in decreased LOS and greater likelihood of discharge to home, but not a mortality benefit. Female, Black and lower income patients were less likely to have prompt intervention.

Keywords: Colon obstruction; Emergency surgery; Large bowel obstruction; Nationwide inpatient sample; Ostomy; Stoma.