The Management of Adhesive Small Bowel Obstruction: A Population-based Analysis of Practices and Outcomes

Background Adhesive small bowel obstruction (aSBO) is a common surgical illness that is characterized by its high likelihood for recurrence. We sought to compare different management strategies during the first admission for aSBO to characterize how early management strategies effect short- and long-term outcomes associated with aSBO. Methods We developed an algorithm to identify patients admitted to hospital for their first episode of aSBO using administrative data collected by the Ministry of Health and Long-Term Care of Ontario. We compared operative management to non-operative management with respect to the cumulative incidence of recurrence and overall survival; we also performed a cost-utility analysis comparing early operative management to a trial of non-operative management; finally, we evaluated the impact of laparoscopic surgery for aSBO on the incidence of bowel injury and peri-operative morbidity and mortality. A variety of quasi-experimental methods were used to estimate causal effects while accounting for potential confounding by indication. Results We identified 40,800 patients admitted for their first episode of aSBO over 2005-2014. Patients managed operatively had a lower risk of recurrence of aSBO [21.1% vs 13.0%, pPh.D.2020-03-21 00:00:0