Oral Water Soluble Contrast Challenge does not affect outcome in Adhesive Small Bowel Obstruction
*Gustavo Bauza1, *Elizabeth Yates1, Frederick H Millham2
1Brigham and Women's Hospital, Boston, MA;2South Shore Hospital, Weymouth, MA
Objective: We reviewed outcomes in adhesive small bowel obstruction (aSBO) before and after implementing an evidence-based oral water soluble contrast challenge protocol (GG).
Design: Retrospective, before and after, cohort study.
Setting: Single community hospital
Intervention: 100 cc of GG PO on admission
Patients: We reviewed all patients over 18 y/o admitted with aSBO over a 6 year period (n=1224). Patients admitted to non-surgical service (536), with a diagnosis other than aSBO (27), requiring surgery on admission day (108) and patients who expired, transferred, were discharged to hospice or left the hospital against advice (25) were excluded. 529 cases were analyzed, 89 of which were on GG.
Main Outcome Measures: Main outcomes measured were median hospital length of stay (LOS) and days from admission to surgery. Secondary outcomes included success of non-operative management (NOM), bowel resection rate, and delay in surgery.
Results: There were no demographic differences between GG and non-GG.
Across both pathways, 159(25%) patients required surgery. Median
LOS for GG was 3 days (IQR 2-4.5) vs non-GG groups 4 days (IQR 2-6), p=0.09. GG were no less likely than non-GG to have LOS>4 days (p=ns). 79 GG (89%) and 398 non-GG (90%) patients had successful NOM (p=ns). Of NOM failures, median days to surgery were 3.5 (IQR 2-7) for GG and 4 (IQR 3-5) for non-GG (p=ns). GG were no less likely to have delay in surgery exceeding 3 days. At surgery, 2 GG (20%) and 16 non-GG (38%) required small bowel resection (p=ns).
Conclusions: Implementation of GG was not associated with shorter LOS, shorter time to surgery, greater likelihood of NOM success or lower resection rate.
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