Does initial management with early surgery influence 30-day mortality in patients with small bowel obstruction?

Introduction

Small bowel obstruction (SBO) is a common surgical emergency with guidelines suggesting non-operative management for up to 80% or patients. International studies report between 50–90%, while prevalence and outcomes of SBO in Sweden are unknown.

The aim was to investigate prevalence, management strategies, and 30-day mortality of patients with SBO in Sweden.

Methods

This nationwide register-based cross-sectional study included adults admitted via Emergency Departments (EDs) with SBO between January 1, 2021, and December 31, 2024. Patients were categorized into non-operative management, early-(<24 h), or delayed surgery (24–72 h). Logistic regression assessed 30-day mortality, adjusting for age,sex, surgery and Charlson Comorbidity Index (CCI), reported as odds ratios (OR).

Results

A total of 49 580 patients were included: 86.9% non-operative, 4.2% early surgery, and 8.8% delayed surgery. Mean age was 70.0, 65.8, and 68.7 years, respectively. Thirty-day mortality was 8.9%, 5.6%, and 6.2%, with median hospital stays of 3, 5, and 7 days. Increasing age (OR 1.06, 95% c.i. 1.05–1.06), male sex (OR 1.16, 95% c.i. 1.07–1.25), and CCI (OR 1.18, 95% c.i. 1.17–1.20) were associated with increased mortality. Delayed surgery (OR 0.83, 95% c.i. 0.73–0.95) was associated with lower mortality, while early surgery did not reach statistical significance (OR 0.87, 95% c.i. 0.71–1.06) compared to non-operative management.

Discussion

The majority of patients with SBO are managed non-operatively in Sweden, although surgery seems to be associated with lower mortality regardless of patient-factors.