Prior Hysterectomy is Associated With Need for Bowel Resection in Women Receiving Surgery for Adhesive Small Bowel Obstruction

Introduction Annually, 300,000 operations are performed for adhesive small bowel obstruction (aSBO). Previous hysterectomy is thought to be a common etiology for aSBO in female patients. However, there are few data that characterize clinical outcomes of patients with prior hysterectomy and aSBO. Methods The National Inpatient Sample (2010-2019) was utilized to identify adults admitted with aSBO as the primary diagnosis. We compared women with a prior history of hysterectomy to male patients with aSBO. The primary outcomes were successful nonoperative management and complicated aSBO, defined as the need for bowel resection or ostomy formation. Secondary outcomes included hospital mortality and length of stay (LOS). Multivariate logistic regression models adjusted for patient characteristics. Results Among 72,055 aSBO patients, 16.3% had prior hysterectomy. Nonoperative management was more frequently successful in women with hysterectomy (62.3% vs 53.6%, P < 0.001), with higher adjusted odds of nonoperative success (OR 1.11, 95% CI 1.06-1.16, P < 0.001). Among operative patients (n = 32,417), bowel resection rates were higher in patients with prior hysterectomy (40.3% vs 33.6%, P < 0.001). There was no significant difference in time to surgical intervention ( P = 0.905). Patients with prior hysterectomy had lower mortality (0.94% vs 2.09%, P < 0.001), and shorter LOS (6.7 vs 7.9 days, P < 0.001). Conclusion Prior hysterectomy is associated with higher rates of successful nonoperative management for aSBO. However, when operative intervention is required, prior hysterectomy is associated with higher rates of bowel resection. Despite this, overall mortality and length of stay are significantly lower in this population.