Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

Surgeons are often presented with the challenge of determining the appropriate management for adhesive small bowel obstruction (aSBO). While non-operative management leaves the responsible adhesions in place, operative management may create new adhesions. Previous studies have suggested that nonoperative management of aSBO may be associated with a greater risk of recurrence, but they have been limited by heterogeneity of the patient cohort. In this propensity-matched retrospective cohort study, 27,904 patients admitted to the hospital with a primary diagnosis of adhesive or unspecified intestinal obstruction (index admission) were studied to compare the cumulative incidence of recurrence of aSBO between patients who underwent operative management at the index admission compared to patients who underwent nonoperative management. Overall, 22.2% of patients underwent operative management at their index admission. These patients were slightly younger (mean age 60.2 years vs. 61.5 years), more likely to be female (57.8% vs. 49.2%), and had fewer comorbidities (low burden, 6.2% vs. 4.2%) than patients who received nonoperative management. Researchers found that patients who underwent operative management at the index admission had a lower risk of recurrence than those undergoing nonoperative management after propensity matching (13.0% vs. 21.3% respectively, HR 0.62, 95% CI 0.56 to 0.68, p<0.001). Furthermore, regardless of the method used to manage previous episodes, patients who underwent operative management during their second and third episodes of aSBO had a significantly lower risk of subsequent recurrence than those who underwent nonoperative management (relative risk reduction [RRR] 51% for second episode, 95% CI 30% to 61%, RRR 55% for third episode, 95% CI 35% to 70%). Importantly, this study suggests that surgical intervention may decrease, not increase, the risk of recurrent aSBO.

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