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Small bowel obstruction in older patients: challenges in surgical management

  • 2021 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Small bowel obstruction (SBO) is a common disease affecting all segments of the population, including the frail elderly. Recent retrospective data suggest that earlier operative intervention may decrease morbidity. However, management decisions are influenced by surgical outcomes. Our goal was to determine the current surgical management of SBO in older patients with particular attention to frailty and the timing of surgery.

Study design

A retrospective review of patients over the age of 65 with a diagnosis of bowel obstruction (ICD-10 K56*) using the 2016 National Inpatient Sample (NIS). Demographics included age, race, insurance status, medical comorbidities, and median household income by zip code. Elixhauser comorbidities were used to derive a previously published frailty score using the NIS dataset. Outcomes included time to operation, mortality, discharge disposition, and hospital length of stay. Associations between demographics, frailty, timing of surgery, and outcomes were determined.

Results

264,670 patients were included. Nine percent of the cohort was frail; overall mortality was 5.7%. Frail had 1.82 increased odds of mortality (95% CI 1.64–2.03). Hospital LOS was 1.6 times as long for frail patients; a quarter of the frail were discharged home. Frail patients waited longer for surgery (3.58 days vs 2.44 days; p < 0.001). Patients transferred from another facility had increased mortality (aOR 1.58; 95% CI 1.36–1.83). There was an increasing mortality associated with a delay in surgery.

Conclusion

Patients with frailty and SBO have higher mortality, more frequent discharge to dependent living, longer hospital length of stay, and longer wait to operative intervention. Mortality is also associated with male gender, black race, transfer status from another facility, self-pay status, and low household income. Every day in delay in surgical intervention for those who underwent operations led to higher mortality. If meeting operative indications, older patients with bowel obstruction have a higher chance of survival if they undergo surgery earlier.

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Acknowledgements

The authors would like to acknowledge the American Association for the Surgery of Trauma Patient Assessment Committee for its contribution to study concept.

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Authors and Affiliations

  1. Department of Surgery, New York University Grossman School of Medicine, New York, CA, USA

    Franchesca Hwang

  2. Department of Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA

    Marie Crandall

  3. Department of Surgery, University of California San Diego Health, 200 West Arbor Drive, #8896, San Diego, CA, 92103-8896, USA

    Alan Smith & Amy E. Liepert

  4. Departments of Surgery and Medicine, London Health Sciences Centre, Western University, London, ON, Canada

    Neil Parry

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  1. Franchesca Hwang
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  2. Marie Crandall
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Correspondence to Amy E. Liepert.

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Drs. Franchesca Hwang, Marie Crandall, Alan Smith, Neil Parry, and Amy Liepert have no conflicts of interest or financial ties to disclose.

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Hwang, F., Crandall, M., Smith, A. et al. Small bowel obstruction in older patients: challenges in surgical management. Surg Endosc 37, 638–644 (2023). https://doi.org/10.1007/s00464-022-09428-y

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  • DOI: https://doi.org/10.1007/s00464-022-09428-y

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