Small Bowel Obstruction Is a Surgical Disease: Patients with Adhesive Small Bowel Obstruction Requiring Operation Have More Cost-Effective Care When Admitted to a Surgical Service

Bilderback, Phillip; Massman, John D.; Smith, Ryan K.; Selva, Danielle La; Helton, W. Scott

doi:10.1016/j.jamcollsurg.2015.03.054

Cited by 45 publications

(37 citation statements)

References 13 publications

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“…Similar findings have been reported in patients presenting with small bowel obstruction. [3,4] We did not specifically look at time to surgery, however the fact that a higher likelihood for a shortened length of stay was only seen in operative patients would be consistent with prior studies showing shorter time to surgery impacting length of stay on surgical services. [16] There were significantly fewer surgical procedures performed following the change in practice (10% versus 17%) which may reflect admission of fewer patients with acute cholecystitis and symptomatic stone disease in the post-protocol period.…”

Section: Discussionmentioning

confidence: 55%

“…[1] It has been common practice for patients with conditions that have traditionally been viewed as surgical to initially be admitted to medical services; this occurs particularly with conditions for which the management is often non-operative. [2,3] The admission decisions can be driven by comorbidities, institutional practice patterns, or other factors. Over recent years, this practice has increasingly come under question with the publication of studies demonstrating the importance of ongoing surgical involvement with patients having potentially surgical conditions, as well as improvement in outcomes associated with admission of these patients to surgical services as opposed to medical services.…”

Section: Introductionmentioning

confidence: 99%

“…Over recent years, this practice has increasingly come under question with the publication of studies demonstrating the importance of ongoing surgical involvement with patients having potentially surgical conditions, as well as improvement in outcomes associated with admission of these patients to surgical services as opposed to medical services. [2][3][4][5] Further reinforcing the argument for more direct responsibility of surgeons in the care of patients with potentially operative conditions is the maturation over recent years of Acute Care Surgery (ACS) as an integral part of Trauma Surgery. [6][7][8] Surgery of the biliary tract is among of the most common surgeries, with over 400,000 cholecystectomies performed in 2012.…”

Section: Introductionmentioning

confidence: 99%

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Direct admission to a surgical service reduces hospital length of stay for patients with biliary disease

Corwin

Reif

Sexton

2019

JHA

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Background: Biliary tract disease is a common condition often necessitating surgical intervention. It has been suggested that categorically admitting these patients to a surgical service rather than a medical service may improve patient outcomes. Our objective was to assess the impact of a protocol change that mandated preferentially admitting patients with biliary disease to a surgical service.Methods: This is a retrospective observational study of patients presenting with biliary disease to a single institution before and after a protocol change that mandated admitting these patients directly to a surgical service. A generalized linear regression model was conducted to analyze the effect of practice change on length of stay, which was primary studied outcome.Results: A total of 3,389 patients were included in the study (n = 1,866 for pre, and n=1,523 for post). There was no difference in hospital length of stay between pre and post groups for non-operative patients (1.9 days ± 4.3 versus 1.9 days ±5.2, p = .972). However, for operative patients, length of stay was shorter for the post group (4.1 days ± 6.1 vs 6.3 days ± 14.0, p = .066). The linear regression model found that operative patients had an increased probability of having a longer length of stay (coefficient, 0.21; 95% CI, 0.14, 0.29; p < .001).Conclusion: Admission of patients with biliary disease to a surgical service rather than a medical service is associated with shorter length of stay for patients who undergo an operative intervention. An approach of admitting all patients presenting with biliary disease to a surgical service has the potential to significantly reduce hospital costs. Our study supports primary responsibility for surgeons in the care of patients with potentially operative conditions.

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Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Direct admission to a surgical service reduces hospital length of stay for patients with biliary disease

Corwin

Reif

Sexton

2019

JHA

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“…Recent findings from retrospective studies indicate that management of patients on a surgical service rather than a medical service is associated with improved outcomes and lower costs. 28,29 In our study, surgeons expressed a concern about subtle changes in physical exam which might be missed by clinicians who have less experience in caring for patients with SBO. The emphasis on early surgeon involvement and serial abdominal exams led many to indicate a preference for patients with SBO to be managed on a surgical service.…”

Section: Discussionmentioning

confidence: 82%

Surgeon attitudes and practice patterns in managing small bowel obstruction: a qualitative analysis

Thornblade

Truitt

Davidson

et al. 2017

Journal of Surgical Research

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INTRODUCTION Historical training instructs surgeons to, “never let the sun set on a small bowel obstruction (SBO)” due to concern for bowel ischemia. However, the routine use of CT scans for ruling out ischemia provides the opportunity for trial of non-operative management, allowing time for resolution of adhesive SBO. In light of advances in practice, little is known about how surgeons manage these patients, in particular, whether there is consistency in the stated duration for safe non-operative management. MATERIAL & METHODS Using a case vignette (a patient with CT-scan diagnosed complete SBO without bowel ischemia), we interviewed a purposive sample of general surgeons practicing in Washington State to understand stated approaches to clinical management. Interview questions addressed typical practice, preferred timing of surgery, and approach. We conducted a content analysis to understand current practice and attitudes. RESULTS We interviewed 15 surgeons practicing across Washington State. Surgical practice patterns for patients with SBO vary widely. The period of time that surgeons were willing to manage patients non-operatively ranged from 1–7 days. Interviews revealed insight into surgical decision making, the importance of patient preferences, variation in practice, and evidence gaps. All surgeons acknowledged a lack of evidence to support appropriate management of patients with SBO. CONCLUSIONS Interviews with practicing surgeons highlight a changing paradigm away from routine early surgery for patients with adhesive SBO. However, there is lack of consensus in the appropriate duration of non-operative management and practices vary considerably. These revealed attitudes inform the feasibility and design of future randomized studies of patients with adhesive SBO.

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“…Consideramos que la realización de ensayos clinicos aleatorizados podría ayudar a esclarecer la pertinencia de la antibióticoterapia en esta patología, que por su alta prevalencia e incidencia podrían tener un impacto valioso en términos de salud, costos de la atención y desenlaces de los pacientes [49,50].…”

Section: Recomendaciones Para Futuras Investigacionesunclassified

Bacteremia secundaria a una traslocación bacteriana, una complicación de la obstrucción intestinal mecánica

2016

UNIV.MED.

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Introduccion: la obstrucción intestinal es el trastorno quirúrgico más frecuente del intestino delgado. Como parte del manejo médico se ha sugerido el tratamiento empírico con antibióticos por el hallazgo patológico de traslocación bacteriana secundaria a la obstrucción. Métodos: se llevó a cabo una revisión de la literatura en las bases de datos Medline, Embase y PubMed y se incluyeron artículos con resultados sobre traslocación bacteriana, fisiología de la barrera intestinal, obstrucción intestinal y microflora intestinal. Resultados: esta revisión pretende explorar la importancia fisiopatológica de la traslocación bacteriana en pacientes con obstrucción intestinal mecánica del intestino delgado, determinar si la traslocación puede ser causante de bacteremia o sepsis y establecer la utilidad del manejo antibiótico. Conclusión: la literatura informa un aumento de riesgo de traslocación a los ganglios linfáticos mesentéricos (14-15,4 %) y de bacteremia (45 %); sin embargo, no existe evidencia conclusiva respecto al uso de antibióticos y se requiere más investigación en este campo.

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Small Bowel Obstruction Is a Surgical Disease: Patients with Adhesive Small Bowel Obstruction Requiring Operation Have More Cost-Effective Care When Admitted to a Surgical Service

Cited by 45 publications

References 13 publications

Direct admission to a surgical service reduces hospital length of stay for patients with biliary disease

Direct admission to a surgical service reduces hospital length of stay for patients with biliary disease

Surgeon attitudes and practice patterns in managing small bowel obstruction: a qualitative analysis

Bacteremia secundaria a una traslocación bacteriana, una complicación de la obstrucción intestinal mecánica

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