Incidence of Adhesive Bowel Obstruction After Colon Cancer Surgery and its Risk Factors: A Nationwide Claim Study.

Abstract

To elucidate the incidence of adhesive postoperative bowel obstruction (PBO) after colon cancer surgery and its risk factors using nationwide claim data. PBO has a significant impact on quality of life and medical costs after colectomy, though most of the literature consists of single-institution analyses. Data from 24,645 patients who underwent regional colectomy for colon cancer from 2010 to 2012 and had at least 3 years of follow up were obtained from the Health Insurance Review and Assessment Service database. Patients who required nasogastric tube insertion or bowel obstruction surgery more than 30 days after index colectomy were defined as having PBO. A total of 3083 (12.5%) patients experienced at least one PBO episode within 3 years after surgery. Logistic regression analysis showed that significant risk factors for PBO were elderly (odds ratio, OR = 1.13), male (OR = 1.27), open colectomy (OR = 1.99), and low-volume institution (OR = 1.17). Among 3083 PBO patients, 50.7% experienced their 1st PBO during the 1st year after the index colectomy, and 7.8% experienced recurrence within 3 years after index colectomy. The 3-year cumulative incidences of PBO according to risk factors of elderly, male, open colectomy, and low-volume institution were 14.6%, 14.3%, 19.5%, and 15.1%, respectively. We report several independent risk factors for PBO and its incidence after regional colectomy for colon cancer. These results are informative for medical providers as patients who will or have had the procedure and could be useful baseline data for further research on the active prevention or treatment of PBO after colectomy.