Timing of surgery, intestinal ischemia and other real factors of mortality in acute adhesive small bowel obstruction: a multiple-center study.

Objective: To analyze the factors of mortality in patients with acute adhesive small bowel obstruction (ASBO).

Material And Methods: A retrospective multiple-center study included 143 (85.6%) patients with ASBO out of 167 consecutive patients with small bowel obstruction for the period 2017-2019. All patients were divided into 3 groups: early surgery group (within 12 hours after admission), late surgery (after 12 hours), non-surgical management group. The outcomes and Kaplan-Meier survival were compared in all groups.

Results: ASBO was resolved without surgery in 77 (53.8%) patients 19.6±17.4 (M=14) hours. In the Early Surgery Group (=36), 24 patients had strangulation, 12 ones had non-strangulated bowel obstruction. In the Late Surgery Group (=30), 15 patients had strangulation and 15 ones had no strangulation. Mortality was similar in early and late surgery (=0.287), early and late surgery in patients with strangulation (=0.940), early and late surgery in patients without strangulation (=0.76). Patients died (=10) after surgery only. Thus, postoperative mortality was 15.2%, overall mortality - 7.0%. All patients who underwent surgery after 24 hours (=14) survived. Surgery increased the mortality risk compared to non-surgical management (95% CI 0 - 15.9, =0.001). There was no effect of surgery time (more or less than 12 hours) on mortality for strangulation (95% CI 13.0-16.7, p 0.788) and non-strangulated obstruction (95% CI 29.4-5.4, =0.061), bowel resection (95% CI 33.3-14.0, =0.187), presence of bowel ischemia (95% CI 14.3-17.9, p 0.613).

Conclusion: Delayed surgery may be advisable in patients with ASBO and no obvious signs of strangulation due to less mortality.