Jose Anna Mary, Kirsch Jordan, Prabhakaran Kartik, Rafieezadeh Aryan, Mehta Riddhi, Shnaydman Ilya, Klein Joshua, Froula Gabriel, Carlson Amanda, Zangbar Bardiya
Department of Surgery, Westchester Medical Center, New York Medical College, Taylor Pavilion, Office D-368, 100 Woods Road, Valhalla, NY, 10595, USA.
Surg Endosc. 2025 Sep 12. doi: 10.1007/s00464-025-12059-8.
Recurrent small bowel obstruction (SBO) can result in significant morbidity and mortality. In this study, we aimed to compare readmission and its impact on operatively and nonoperatively managed patients admitted with SBO.
We performed a retrospective analysis using the National Readmission Database 2016-2017 and included all patients (≥ 18y) who were non-elective admissions for SBO during the index hospitalization. Patients were dichotomized into two groups: Operative group (OM) and nonoperative group (NOM). Primary outcomes included rates of readmission and mortality upon readmission. Secondary outcomes included complications, which were defined as fistula, abscess, perforation, peritonitis, and sepsis.
122,778 patients admitted for SBO were included. Overall, the readmission was 29.8%, with 34.4% readmitted within 30 days. 6.4% were OM, while 93.6% were NOM during index admission. Among OM patients, the readmission rate was significantly lower at 28.6% compared to NOM at 29.9% (p < 0.001). Among the readmitted NOM patients, 88.3% had emergency readmissions, with 10.6% requiring operative intervention. Adjusted analyses revealed that NOM had 32% higher odds of readmission (p < 0.001). Other factors increasing the odds of readmission included female sex, a high Charlson comorbidity index, and an admission diagnosis of cancer. Among readmitted patients, NOM had 50% higher odds of mortality during readmission. Each readmission raised the odds of mortality by 4.0% (p < 0.001). Operative management in the first readmission was associated with younger age, private insurance status, and non-operative management during the index admission.
While cost, length of stay, and complications were higher in OM, NOM was associated with a higher readmission rate and mortality upon readmission. Each additional readmission for small bowel obstruction increased the odds of mortality by 4.0%.
复发性小肠梗阻（SBO）可导致显著的发病率和死亡率。在本研究中，我们旨在比较再次入院情况及其对因SBO入院的手术治疗和非手术治疗患者的影响。
我们使用2016 - 2017年国家再入院数据库进行了一项回顾性分析，纳入了所有在首次住院期间因SBO非选择性入院的患者（≥18岁）。患者被分为两组：手术组（OM）和非手术组（NOM）。主要结局包括再入院率和再入院时的死亡率。次要结局包括并发症，定义为瘘、脓肿、穿孔、腹膜炎和脓毒症。
纳入了122778例因SBO入院的患者。总体而言，再入院率为29.8%，其中34.4%在30天内再次入院。首次入院时，6.4%为OM患者，93.6%为NOM患者。在OM患者中，再入院率显著低于NOM患者，分别为28.6%和29.9%（p < 0.001）。在再次入院的NOM患者中，88.3%为急诊再入院，10.6%需要手术干预。校正分析显示，NOM的再入院几率高32%（p < 0.001）。增加再入院几率的其他因素包括女性、高Charlson合并症指数和癌症入院诊断。在再次入院的患者中，NOM的再入院死亡率高50%。每次再入院使死亡率几率增加4.0%（p < 0.001）。首次再入院时的手术治疗与年龄较小、有私人保险状态以及首次入院时的非手术治疗有关。
虽然OM患者的费用、住院时间和并发症较高，但NOM与更高的再入院率和再入院时的死亡率相关。小肠梗阻每增加一次再入院，死亡率几率增加4.0%。
