Maria S Altieri, MD1, Lisa A Bevilacqua, MD2, Jie Yang, PhD1, Chencan Zhu, MS1, Konstantinos Spaniolas, MD1, Mark Talamini, MD, FACS, MBA1, Aurora D Pryor, MD, FACS1. 1Stony Brook University School of Medicine, 2Thomas Jefferson University Hospitals
INTRODUCTION: Small Bowel Obstruction (SBO) is a common pathology requiring surgical workup and treatment; it is also often a consequence of prior abdominal surgery. Admissions for SBO and abdominopelvic adhesions have been estimated as high as 350,000 per year in the US alone. However, little is known regarding the anticipated clinical course of patients presenting to an emergency department (ED) with SBO. This includes rates of admission, need for surgery, or transfer to a tertiary care facility. This study aims to identify all patients who presented to the ED in New York State with SBO and follow their clinical course, with a focus on predictors of transfer.
METHODS AND PROCEDURES: The New York SPARCS administrative database was used to identify all patients who presented to an ED with the diagnosis of SBO between 2012-2014. Patients were followed to identify discharges from the ED, admissions, operations, and transfers. To evaluate predictors of transfer, Chi-square tests with exact p-values based on Monte Carlo simulation were utilized to examine the marginal association between categorical variables and transfers. Factors that were significantly associated with transfer (p<0.05) were further evaluated as possible risk factors for transfer in a multivariable logistic regression model.
RESULTS: Between 2012-2014, there were 43,567 ED visits for SBO from 35,646 patients. Figure 1 shows the percentage discharged, admitted, transferred, and deceased. Of those requiring surgery, 94.2% underwent an operation at the initial presenting institution while 5.8% had surgery after transfer. The mean time-to-surgery was 0.7 days (SD=0.83) and 2.47 days (SD=4.82) at presenting and transfer institutions, respectively. Independent predictors for transfer included age over 18-29 (p=0.03), white non-Hispanic race/ethnicity (p<0.0001), and location in Western NY (p<0.0001). There was no effect of insurance status on transfer (p=0.38). Interestingly, presence of any comorbidity resulted in a lower likelihood of transfer while any complication during initial visit significantly increased the likelihood of transfer.
CONCLUSIONS: To our knowledge, this is the first study that examines what happens to patients presenting with SBO in the ED using a large state-wide database. We found an in-hospital mortality rate of 1.9%, a surgery rate of 17.6% during initial visit, and a transfer rate of 4.5%. Further research is needed to determine demographic and clinical predictors of these outcomes.
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Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95100
Program Number: P037
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster