Use of Small Bowel Follow Through in Management of Small Bowel Obstruction.

Abstract

Background: Small bowel obstructions (SBOs) are a burden to healthcare. Despite a common disease, significant inconsistencies exist within management, specifically use of small bowel follow through (SBFT). We evaluated patients who had SBFT and the early vs late use of SBFT on outcomes.

Study design: A retrospective chart review was performed for 799 patients with SBO admitted between 2012 and 2019. Patients between 18 and 89 years of age were included and those who required emergent operations on admission were excluded. The groups were evaluated by having SBFT compared with not, and further delineated on SBFT performance before (early) or after (late) 48 hours.

Results: Of the 799 patients with an SBO, 757 (94.7%) had SBFT and 42 (5.2%) did not. Of those 757, 476 (62.8%) performed early and 281 (37.1%) completed late. In patients who received SBFT, the length of stay (LOS) was shorter (p < 0.003). If patients were admitted to the surgical service, they were more likely to receive an SBFT (p < 0.0042). When SBFT was early, patients were more frequently admitted to an academic institution (p < 0.0001) and to a surgical service (p < 0.0001), had decreased LOS (p < 0.001), decreased readmissions (p < 0.0001), were less likely to require surgery (p < 0.0009), had decreased time to operation (p < 0.0001), and had quicker operation to discharge (p < 0.0005).

Conclusions: The use of SBFT for SBO resulted in improved outcomes, especially if performed early. This is supportive of surgical service admission with more frequent early SBFT with decreased LOS. There is a propensity for those patients with previous operations to have SBFT later in hospital stay and may correlate with increased need for surgery, and the use of early SBFT may help resolve SBO. Implementing early SBFT may improve outcomes and an area of future endeavors.