Modifiable Surgeon-Related Variability Affects Outcome of Small Bowel Obstruction
Amy Fitzpatrick, MD, Frederick H. Millham, MD, MBA
Brigham and Women’s Hospital, Boston, MA
PURPOSE OF STUDY
Adhesive small bowel obstruction (SBO) is a common surgical problem. We wondered if surgeon behavior was an independent variable important in outcome of SBO.
We reviewed the charts for 176 consecutive SBO admissions to a community teaching hospital. We recorded demographic variables, physical findings, laboratory and radiologic data, vital signs available on admission. We measured the days from admission to surgery (if any) and time from surgery to return of bowel function. We abstracted abdominal surgery histories. We looked for factors associated with various outcomes by univariate and multivariate statistical tests. Outcome variables included: LOS, pre-surgical LOS, surgical complication, days to return of bowel function and requirement for bowel resection.
SUMMARY OF RESULTS
Median age of SBO patients was 68.5 (Range 23-97). Median LOS for all subjects was 4 days (Range 1 to 27). There were two deaths. 116 patients were experiencing their first SBO. 89 (51%) required surgery. CT read as “closed loop obstruction” was the only factor associated with need for surgery (p<0.014). Delay in surgery was associated with the occurrence of a complication (p<0.04 and p<0.03). There was a trend toward delay in return of bowel function due to delay in surgery. When potential confounders were controlled for, surgeon was a significant factor in overall LOS and days from admission to operation.
Delay in decision to operate on patients with SBO varies between surgeons even when potential confounding variables are controlled for. This delay prolonged LOS, time to return of bowel function and may increase odds of a surgical complication.