32: Incidence and risk factors of early post-operative small bowel obstruction in patients undergoing hysterectomy for benign indications

Abstract

The objective of this study was to evaluate the incidence of and risk factors for early small bowel obstruction (SBO), occurring within the first month of surgery, after benign hysterectomy. This was a retrospective cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program database from 2014 to 2016. Current Procedural Terminology codes were used to identify patients undergoing hysterectomy for benign indications with or without concomitant colpopexy, lysis of adhesions (LOA), adnexectomy, or appendectomy. Patient demographics, clinical and surgical factors were obtained. Patients were then stratified into those with and without and SBO. Differences between groups were evaluated using Chi-squared and Fisher’s exact tests for categorical variables, and the Student’s t-test for continuous variables. Multivariable logistic regression was used to identify significant independent predictors of SBO. There were 286 (0.06%) occurrences of SBO out of 47,937 hysterectomies. Patients experiencing SBO were more likely to undergo abdominal hysterectomy (72.0% vs 21.2%, p<0.001), LOA (5.2% vs 2.1%, p<0.001), appendectomy (1.7% vs 0.5%, p=0.02), and cystotomy repair (1.0% vs 0.3%, p= 0.002). After logistic regression, mode of hysterectomy was not a significant predictor of SBO, while contaminated and infected wounds (aOR=5.93, 95% CI: 2.71-12.96) and perioperative transfusion (aOR=5.21, 95% CI: 3.66-7.29) were the most significant risk factors. Additional risk factors for early SBO included non-white race (aOR= 1.83, 95% CI: 1.34-2.48), older age (aOR=1.03, 95% CI: 1.02-1.05), prior abdominal or pelvic surgery (aOR=1.45, 95% CI: 1.26-2.60), operating times exceeding 170 minutes (aOR=1.90, 95% CI: 1.39-2.59), uterine weight greater than 250 grams (aOR=1.54, 95% CI: 1.11-2.14), lysis of adhesions (aOR=2.12, 95% CI: 1.24-3.66), and concurrent appendectomy (aOR=2.98, 95% CI: 1.20-7.41). Early small bowel obstruction is a rare complication of benign hysterectomy and is unrelated to route of hysterectomy after adjusting for confounders. Multiple risk factors related to abdomino-pelvic adhesive disease were associated with a higher risk of bowel obstruction.View Large Image Figure ViewerDownload Hi-res image Download (PPT)