Management of adhesive small bowel obstruction during pregnancy in the United States.

Abstract

Background: Adhesive small bowel obstruction (ASBO) is a rare, nonobstetrical abdominal emergency. Optimal management of ASBO during pregnancy remains unknown. This study analyzes management trends and outcomes of pregnant patients with ASBO in the United States.

Methods: The National Inpatient Sample was queried for pregnant women diagnosed with ASBO from January 2003 to September 2015. Patients were grouped into three management strategies: nonoperative management (NOM), immediate operation (from admission to hospital day 1), or delayed operation (after hospital day 1). Multivariable regression analysis was used to evaluate the association between management strategies and maternal or perinatal complications. The impact of delayed operation on patient outcomes was also assessed.

Results: A total of 4,266 pregnant patients with ASBO were identified: 1,974 (46.3%) were managed nonoperatively, 1,177 (27.6%) underwent immediate operation, and 1,115 (26.1%) underwent delayed operation. The rate of NOM did not significantly change over the study period. Compared with NOM, immediate operation was not associated with increased complication rates, whereas delayed operation was associated with higher rates of maternal septic shock (odds ratio [OR], 5.63; 95% confidence interval [CI], 1.09-29.21; p = 0.04) and preterm labor, delivery, or abortion (OR, 2.41; 95% CI, 1.56-3.72; p < 0.001). In analysis of patients who underwent surgery, each day of delay in operation was associated with a 14% higher chance of preterm labor, delivery, or abortion (OR, 1.14; 95% CI, 1.08-1.21; p < 0.001).

Conclusion: Pregnant patients presenting with ASBO were often managed operatively. Delay to operation was associated with increased odd of maternal and perinatal complications. Surgeons should be involved early in determining the optimal management for ASBO.

Level of evidence: Therapeutic/Care Management; Level IV.