Early Use of Small Bowel Follow Through Reduces Stay and Cost in Small Bowel Obstructions

Abstract

BackgroundAccording to the Nationwide Inpatient Sample in 2011, nearly 1,500,000 admissions with over 300,000 laparotomies were performed for adhesion-related small bowel obstructions (SBOs). Small bowel follow through (SBFT) consists of serial X-rays with oral Gastrografin contrast that can diagnose obstructions requiring operative intervention. Furthermore, the contrast has a therapeutic osmotic effect which may promote transit and resolve an SBO. The aim of the study was to determine if early SBFT administration to patients with SBO decreases length of stay (LOS), hospital costs, and can identify patients who will fail nonoperative management (NOM). MethodologyThis is a single institution retrospective study conducted from 2010 to 2019 with a total of 476 patients. We divided patients into three groups: SBFT within <24 hours of admission (n = 40), SBFT >24 hours after admission (n = 198), and did not receive SBFT (n = 238). We compared the overall LOS, hospital costs, and time from SBFT to the operating room using an analysis of variance. ResultsLOS significantly differed between groups with SBFT within ≤24 hours having an average LOS of 6.95 days compared to 10.65 days in the SBFT after >24 hours and 11.75 days in the no SBFT group (p = 0.005). Median time to the operating room in patients receiving SBFT was one day, which was significantly shorter than a median time of four days for no SBFT group (p = <0.05). Decreased LOS by 4.8 days equated to saving $8,657 per patient. ConclusionsSBFT administered within 24 hours decreases LOS, overall costs, and time to operating room in patients who fail NOM.

Financial and Inpatient Burden of Adhesion-Related Small Bowel Obstruction: A Systematic Review of the Literature

“…Several studies have addressed this measure for expediting conservative treatment of patients with ASBO. [22][23][24] A randomized trial of gastrografin administration in patients with ASBO, demonstrated that while gastrografin significantly reduced the hospital stay for patients managed conservatively, did not reduce the need for an operation. 22 A more recent systematic review 23 confirmed these same findings.…”

Management of small bowel obstruction and systematic review of treatment without nasogastric tube decompression

“…The high osmolarity of WSC creates a pressure gradient leading to rapid fluid shifts into the tracheobronchial lumen resulting in pulmonary edema and respiratory failure [ 26 ]. Previous studies have examined the benefit of barium contrast for the treatment of aSBO, however these studies either did not stratify outcomes based on barium vs. WSC [ 27 ] or used a mixture of barium and WSC [ 28 ], yielding negative results. Previous studies of WSC for the treatment of aSBO reported few cases of pulmonary complications, suggesting that in the setting of a functioning NGT, WSC administration is safe [ 16 ].…”

The Effect of Hyperosmolar Water-Soluble Contrast for the Management of Adhesive Small Bowel Obstruction

“…Of the 4879 articles obtained in the initial search, 28 were selected for full text review. After manual review of the full text articles, 8 studies were excluded (4 lacked control groups, [9][10][11][12] 2 used barium as contrast agent, 13,14 1 used a low osmolarity WSC agent 15 and 1 had overlap of patients receiving WSC between study groups 16 ), resulting in 20 (11 RCTs and 9 observational studies) articles for the final analysis (Supplement Digital Content: Table 1, http://links.lww.com/SLA/E24). The included studies were published between 1994 and 2021 and included a total of 4761 patients and 4896 aSBO episodes.…”