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

Abstract

BackgroundLarge bowel obstruction is an urgent condition which can progress to ischemia and perforation. The importance of prompt intervention has not been rigorously demonstrated. MethodsPatients 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. ResultsAmong 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. ConclusionPrompt 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.