Operative and non-operative management of small bowel obstruction in colorectal cancer hospitalizations: A national inpatient sample analysis.

Abstract

e15630 Background: Small Bowel Obstruction (SBO) is a common and serious complication among patients with Colorectal cancer (CRC). Admissions are usually clinically challenging. There is limited contemporary data on the outcomes of operative and non-operative treatments. Methods: We conducted a retrospective cross-sectional study using the National Inpatient Sample (NIS) database for the years 2018-2022. Adults aged 18 years with CRC and SBO who were hospitalized were identified. Management was classified as operative versus non-operative based on procedure coding. The primary outcome was in-hospital mortality; secondary outcomes were length of stay (LOS) and total hospital charges (TOTCHG). Baseline characteristics and outcomes were compared using survey-weighted tests. Survey-weighted multivariable logistic regression was used to estimate adjusted odds of mortality. Models adjusted for age, sex, race, payer, ZIP-income quartile, hospital region, teaching status, bed size, and comorbidities (CKD, CHF, DM, HTN, COPD, obesity). Results: The CRC+SBO cohort represented a weighted population of ~101,645 hospitalizations (unweighted n≈20,329). In-hospital mortality was lower with operative than with non-operative management (4.83% vs 8.09%, design-based p < 0.001). LOS distribution differed significantly by management (design-based p < 0.001): LOS 0–3 days (12.19% operative vs 45.56% non-operative), 4–7 days (30.10% vs 32.42%), 8–14 days (34.43% vs 16.05%), and ≥15 days (23.28% vs 5.98%). Mean charges were substantially higher with operative management ($148,487 [95% CI 145,345–151,629]) compared with non-operative ($53,589 [95% CI 51,742–55,436]). In adjusted analysis, operative management remained associated with lower in-hospital mortality (aOR 0.53, 95% CI 0.45–0.62; p < 0.001). Increasing age was associated with higher mortality (aOR 1.03 per year, p < 0.001). CHF (aOR 1.79, p < 0.001), CKD (aOR 1.35, p = 0.003), and COPD (aOR 1.35, p = 0.012) were associated with higher mortality. Female sex was associated with modestly lower mortality (aOR 0.85, p = 0.034). A higher ZIP income quartile (Q4 vs Q1) was associated with lower mortality (aOR 0.70, p = 0.003). Conclusions: In a national cohort of CRC hospitalizations complicated by SBO, operative management was associated with significantly lower adjusted in-hospital mortality, but substantially longer length of stay and higher hospital charges. These findings reinforce the need for risk-stratified decision-making based on patients who will gain the greatest benefit from surgery, and resource utilization to decrease length of stay and charges. There is a need for prospective studies to determine which CRC+SBO patients gain the greatest survival benefit.