How Common Are Small Bowel Obstructions?
Small bowel obstruction is an extremely common surgical emergency, accounting for approximately 12-16% of all hospital admissions for abdominal pain in the United States and representing nearly 50% of all emergency laparotomies. 1, 2, 3
Epidemiologic Burden
SBO results in more than 300,000 operations annually in the United States alone. 2
In the United Kingdom, small bowel obstruction was the indication for 51% of all emergency laparotomies. 1
Among the top emergency surgical procedures in the USA, adhesive small bowel obstruction was the most common diagnosis for both small bowel resection (top 2 procedure) and adhesiolysis (top 5 procedure), accounting for 80% of all general surgery emergency admissions, morbidity, deaths, and healthcare expenditures. 1
Etiology and Causation
Post-operative adhesions are the leading cause of small bowel obstructions, accounting for approximately 60% of all cases. 1
Even in patients with virgin abdomen (no previous abdominal surgery), adhesions were found to be the cause in approximately 50% of cases. 1
Malignancy causes 4-13% of small bowel obstructions. 4
Clinical Impact and Healthcare Costs
ASBO causes an average hospitalization of 8 days with an in-hospital mortality rate of 3% per episode. 1
Between 20-30% of patients with adhesive small bowel obstruction require operative treatment. 1
Average hospitalization after surgical treatment is 16 days, compared to only 5 days following non-operative treatment. 1, 5
Associated costs are substantial: €16,305 for surgical treatment versus €2,227 for non-operative treatment in a 2016 Dutch study. 1
Recurrence Rates
12% of non-operatively treated patients are readmitted within 1 year, rising to 20% after 5 years. 5
8% of operatively treated patients experience recurrence after 1 year and 16% after 5 years. 5
Younger patients have a higher lifetime risk for recurrent episodes. 5
Special Populations
Small bowel obstruction during pregnancy is rare but represents a significant clinical challenge with approximately 17% risk of fetal loss and 2% maternal mortality. 4
Elderly patients with small bowel obstruction have significantly higher morbidity and mortality rates, with advanced age and high ASA scores being independent predictors of death. 6, 7