Objectives: Small bowel obstructions (SBO) account for a significant burden on the global healthcare system. Should the ongoing trend of regionalizing medicine extend to these patients? We aimed to find out if there is a benefit to admitting SBO’s to larger teaching hospitals and to surgical services.
Methods: We performed a retrospective chart review of 505 patients who were admitted to a Sentara Facility between 2012 and 2019 with a diagnosis of SBO. All patients between the ages of 18 – 89 were included. Patients were excluded if they required an emergent operation. Comparisons were then made between patients admitted either to a teaching hospital or a community hospital as well as the specialty of the admitting service.
Results: Out of 505 patients admitted with a SBO, 351 (69.5%) were admitted to a teaching hospital. 392 (77.6%) of the total patients were admitted to a surgical service. The average length of stay (4 vs 7, p < 0.0001) and cost ($18,069.79 vs $26,458.20, p < 0.0001) were lower at teaching hospitals. The same trends in LOS (4 vs 7, p < 0.0001) and cost ($18,265.10 vs 29,944.82, p < 0.0001) were seen with regards to patients admitted to a surgical service. The 30 day readmission rate was higher in patients admitted to a teaching hospital (18.2% vs 11%, p = 0.0429) and those patients admitted to medical services were generally older (64 vs 69, p < 0.0001). There was no difference seen in operative rate or mortality between the groups.
Conclusion: These data would suggest that there is a benefit to patients with a SBO being admitted to larger teaching hospitals and to surgical services with regards to length of stay and total hospital cost, suggesting that these patients might best be treated at centers with Emergency General Surgery Services.
