| アブストラクト | BACKGROUND: Non-operative management (NOM) is widely used for uncomplicated small bowel obstruction (SBO), but failure of NOM may lead to adverse outcomes. The optimal duration of NOM before surgery remains unclear. This study aimed to identify a safe time window for NOM using a nationwide real-world dataset in Japan. STUDY DESIGN: We performed a retrospective cohort study using the Japanese Diagnosis Procedure Combination (DPC) database, including 11,034 adult patients who underwent surgery for SBO between 2016 and 2020. Patients were grouped based on the number of days from admission to surgery: 0-3 (Group 1), 4-7 (Group 2), 8-13 (Group 3), and 14-28 days (Group 4). Multivariate logistic regression assessed the association between surgical timing and outcomes. RESULTS: There was no significant difference in the reoperation rate requiring general anesthesia (Group 2; P=0.654, Group 3; P=0.415, Group 4; P=0.708) or in-hospital mortality rate (Group 2; P=0.074, Group 3; P=0.529, Group 4; P=0.695) between groups. The bowel resection rate was significantly higher in Groups 2-4 compared to Group 1 (ORs: 1.53, 2.08, 2.19; p<0.001). Aspiration pneumonia was significantly more frequent in Group 4 (OR: 1.74; p<0.001). Reoperation and in-hospital mortality rates did not differ significantly between groups. Fatal cases had higher pneumonia and transfusion rates but lower bowel resection rates, suggesting perioperative condition rather than surgical timing may influence mortality. CONCLUSIONS: Extending NOM beyond 3 days increases the risk of bowel resection, and beyond 14 days raises the risk of aspiration pneumonia. These findings support early surgical consideration. |
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| ジャーナル名 | Journal of the American College of Surgeons |
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| Pubmed追加日 | 2025/8/29 |
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| 投稿者 | Yamada, Takeshi; Oba, Takuya; Uehara, Kay; Matsuda, Akihisa; Otani, Makoto; Matsuda, Shinya; Ohta, Ryo; Sonoda, Hiromichi; Yoshida, Hiroshi; Hirata, Keiji |
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| 組織名 | Department of Gastroenterological Surgery, Nippon Medical School, Tokyo, Japan.;Department of Surgery 1, School of Medicine, University of Occupational and;Environmental Health, Fukuoka, Japan.;Occupational Health Data Science Centre, University of Occupational and;Department of Preventive Medicine and Community Health, School of Medicine,;University of Occupational and Environmental Health Fukuoka, Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/40879160/ |
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