Surgery for adhesive small-bowel obstruction associated with lower recurrence risk

With each episode, the probability of another recurrence within five years increased until surgical intervention occurred, and after surgical intervention, risk for subsequent recurrence decreased by about 50%.

Recurrence rates for adhesive small-bowel obstruction may be lower with initial surgical management versus nonsurgical management, a recent study reported.

Researchers in Canada performed a longitudinal, propensity-matched, retrospective cohort study using health administrative data to compare recurrence incidence with initial surgical versus nonsurgical management for adhesive small-bowel obstruction. Patients were included in the study if they were adults 18 to 80 years of age who were admitted to the hospital for a first episode of adhesive small-bowel obstruction from April 1, 2005, through March 31, 2014. The study's primary outcome was cumulative incidence of recurrence after index admission, and the secondary outcome was incidence of additional recurrences after a second episode of adhesive small-bowel obstruction. The study results were published Jan. 30 by JAMA Surgery.

Overall, 27,904 eligible patients were admitted with a first episode of adhesive small-bowel obstruction, and of these, 6,186 (22.2%) had surgery. The mean patient age was 61.2 years; slightly more than half of the patients (51.1%) were women. Maximum follow-up after the index episode was 10 years, and the median follow-up interval was 3.6 years. Surgery was more common in patients who were younger (mean age, 60.2 years vs. 61.5 years) and in those who had fewer comorbid conditions. Risk for recurrence after matching was lower in those with surgical management than in those with nonsurgical management (13.0% vs. 21.3%; hazard ratio, 0.62; P<0.001). With each episode, the probability of another recurrence within five years increased until surgical intervention occurred. After surgical intervention, a decrease of approximately 50% was noted in the risk for subsequent recurrence, the researchers said.

No data were available on patients' surgical histories, and there was a risk for misclassification bias given the use of administrative data, among other limitations, the researchers noted. However, they concluded that surgical intervention for adhesive small-bowel obstruction appeared to be associated with lower risk for recurrence both for the initial episode and during subsequent episodes. “Contrary to dogma, these data suggest that surgical intervention mitigates rather than increases the probability of recurrent [adhesive small-bowel obstruction],” the researchers wrote. They called for consideration of the long-term recurrence risk when managing patients with this condition.