[Immediate and long-term treatment outcomes in patients with adhesive small bowel obstruction (recurrence rate, redo surgeries and mortality): a multiple-center study].

OBJECTIVE

To analyze immediate and long-term outcomes of surgical and non-operative management (NOM) for adhesive small bowel obstruction (ASBO) using the Moscow Unified Medical Information and Analytical System (EMIAS).

MATERIAL AND METHODS. WE: Retrospectively analyzed 366 patients with ASBO in 7 Moscow hospitals between January 01, 2017 and December 31, 2019. Treatment outcomes after surgery and NOM were analyzed throughout 6 years after baseline hospitalization.

RESULTS

At baseline hospitalization, mean hospital-stay for successful NOM was 6.3 (95% CI 4.3-8.2) days shorter compared to surgery (5.5±5.1 vs. 11.8±10.9 days, p<0.001). In-hospital mortality was significantly higher after surgical interventions (12.3% vs. 0.4%, p<0.001). Over a 6-year follow-up, cumulative probability of rehospitalization due to recurrent bowel obstruction was 25.8% for NOM vs. 11.6% for surgery (p=0.005). However, redo surgery rates showed no significant difference: 4.5% (NOM) vs. 5.8% (surgery). Overall survival was higher in non-operated patients (HR 1.82; 95% CI 1.21-2.72; p=0.004).

CONCLUSION

Over a 6-year follow-up, NOM was associated with lower mortality compared to surgical intervention but higher recurrence rates of adhesive small bowel obstruction. The need for reoperation did not differ between both groups.