Background

Early small bowel obstruction (eSBO) (within 30-days) presents a rare yet concerning complication, necessitating high rates of reoperation. Patient-specific and intraoperative characteristics may predispose patients to eSBO. We hypothesized eSBO is influenced by patient-specific and intraoperative factors, helping identify at-risk individuals perioperatively.

Methods

Examining the 2015-2021 MBSAQIP, 1,346,468 cases were reviewed, excluding pediatric, revisional, open-conversion, and cases missing data (sex/BMI/operative-time/<30-day-follow-up). In total, 1,016,484 records were included. in the final analysis. Baseline characteristics and case details were collected and compared using Fisher's exact & Wilcoxon-Mann-Whitney tests, though the likelihood of eSBO was modeled with rare event logistic regression.

Results

Incidence of eSBO was 0.40%. Of the 4,103 occurrences of eSBO; Roux-en-Y bypass (RYGB), sleeve gastrectomy (SG), and duodenal switch (DS) accounted for 79.4%, 19.3%, and 1.3%, respectively. Many patient-specific characteristics were significantly associated with eSBO (Table 1); including, prior foregut surgery, a non-MBS-trained operator, and longer operative times, which were all associated with increased eSBO (p= <.0001). When adjusted in a rare event logistic regression, eSBO was significantly higher in DS (OR 9.55, p=<.0001) and RYGB (OR 5.18, p= <.0001) compared to SG. Increased operative-length (OR 1.03, p= <.0001) and non-MBS-trained operators (OR 1.33, p= <.0001) remained highly significant. Male-sex (OR 0.70, p= <.0001) and diabetes (OR 0.78, p= <.0001) were both protective.

Conclusions

In the largest analysis to date, SBO remains a rare 30-day event in MBS. RYGB accounts for the largest proportion of eSBO, however DS affords a higher adjusted risk of eSBO in a rare events model.