School of Medicine and Health Sciences Poster Presentations

Title

Nasogastric Decompression is Associated with Increased Hospital Length of Stay but No Reduction in Need for Surgery in ED Patients with Acute Small Bowel Obstruction

Document Type

Poster

Keywords

Small bowel obstruction; emergency department; nasogastric decompression; treatment efficacy

Publication Date

Spring 2017

Abstract

Title

Nasogastric Decompression is Associated with Increased Hospital Length of Stay but No Reduction in Need for Surgery in ED Patients with Acute Small Bowel Obstruction

Background

Small bowel obstruction (SBO) is one of the most common causes of surgical admissions, occurring nearly 300,000 times per year and costing the US healthcare system an estimated $1.3 billion dollars annually. Standard early management of acute SBO includes Nasogastric (NG) decompression of the GI tract proximal to the obstruction. This procedure is uncomfortable for patients and there is controversy regarding its clinical benefit. The primary objective of this study was to determine if NG decompression was associated with a reduction in surgical management of small bowel obstruction.

Methods

We performed a retrospective chart review of 181 patients admitted to an urban academic teaching hospital from the Emergency Department (ED) with a diagnosis of small bowel obstruction and CT confirmation over a two-year period from September 2013 – September 2015. All subjects received an abdominal CT scan read by attending radiologist as either “definite” or “likely” SBO. Using established methods of chart review, a team of abstractors collected data regarding demographic characteristics, past medical history, clinical signs, ED course and hospital course. To accomplish the primary objective, we compared patients who received NG decompression with those that did not, to primary endpoints of surgical intervention, bowel resection during surgery, and hospital length of stay (LOS).

Results

Among subject population, 93 (51%) of patients received NG decompression and 88 (49%) did not. There was no significant difference in baseline characteristics between the two groups. In patients who received NG decompression, there was no association with a reduction in surgery (p=0.20) or bowel resection (p =0.41.) A significantly increased distribution of median hospital length of stay for those receiving NG decompression versus those who did not receive NG decompression was observed of 5 days versus 3 days (p<0.0001.)

Conclusion

NG decompression is not associated with a reduction in surgery or a reduction in need for bowel resection but is associated with an increase in hospital length of stay. Future prospective randomized studies are needed to confirm these associations.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Comments

Poster to be presented at GW Annual Research Days 2017.

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Nasogastric Decompression is Associated with Increased Hospital Length of Stay but No Reduction in Need for Surgery in ED Patients with Acute Small Bowel Obstruction

Title

Nasogastric Decompression is Associated with Increased Hospital Length of Stay but No Reduction in Need for Surgery in ED Patients with Acute Small Bowel Obstruction

Background

Small bowel obstruction (SBO) is one of the most common causes of surgical admissions, occurring nearly 300,000 times per year and costing the US healthcare system an estimated $1.3 billion dollars annually. Standard early management of acute SBO includes Nasogastric (NG) decompression of the GI tract proximal to the obstruction. This procedure is uncomfortable for patients and there is controversy regarding its clinical benefit. The primary objective of this study was to determine if NG decompression was associated with a reduction in surgical management of small bowel obstruction.

Methods

We performed a retrospective chart review of 181 patients admitted to an urban academic teaching hospital from the Emergency Department (ED) with a diagnosis of small bowel obstruction and CT confirmation over a two-year period from September 2013 – September 2015. All subjects received an abdominal CT scan read by attending radiologist as either “definite” or “likely” SBO. Using established methods of chart review, a team of abstractors collected data regarding demographic characteristics, past medical history, clinical signs, ED course and hospital course. To accomplish the primary objective, we compared patients who received NG decompression with those that did not, to primary endpoints of surgical intervention, bowel resection during surgery, and hospital length of stay (LOS).

Results

Among subject population, 93 (51%) of patients received NG decompression and 88 (49%) did not. There was no significant difference in baseline characteristics between the two groups. In patients who received NG decompression, there was no association with a reduction in surgery (p=0.20) or bowel resection (p =0.41.) A significantly increased distribution of median hospital length of stay for those receiving NG decompression versus those who did not receive NG decompression was observed of 5 days versus 3 days (p<0.0001.)

Conclusion

NG decompression is not associated with a reduction in surgery or a reduction in need for bowel resection but is associated with an increase in hospital length of stay. Future prospective randomized studies are needed to confirm these associations.