The vicious cycle of nonoperatively managed adhesive small bowel obstruction: does weekend admission play a role?

BACKGROUND: Data on the influence of nonpatient factors, such as day of admission, on adhesive small bowel obstruction (aSBO) management are limited. This study assesses the association between weekend admission, management approach, and postdischarge outcomes. METHODS: We conducted a retrospective cohort study using the 2020 and 2021 National Readmission Database. Adult patients admitted with aSBO between January and March of each study year were followed for 9 months after discharge. Patients were stratified by admission day (weekend vs weekday) and management (nonoperative [NOM] vs operative [OM]). The primary outcome was the association between weekend admission and management approach. Secondary outcomes included recurrence, all-cause readmission, and mortality through 9 months after discharge. Multivariable logistic regression was adjusted for illness severity, mortality risk, and other confounders. RESULTS: Among 60,960 patients with aSBO, 16,586 (27.2%) were admitted on weekends. The mean (SD) age was 65.6 (15.9) years, and 55.6% of patients were female. Weekend admission was associated with a higher rate of NOM (83.7% vs 81.4%; P <.001) and a 17% higher relative risk (RR) of NOM (RR, 1.17; 95% CI, 1.03-1.33). Despite greater illness severity among operatively managed patients (P <.001), NOM was independently associated with significantly higher odds of all-cause readmission, aSBO recurrence, and all-cause mortality through 9 months after discharge. CONCLUSION: Weekend admission independently predicted NOM for aSBO. More than one-third of the patients managed nonoperatively were readmitted within 9 months of discharge, and NOM was independently associated with more than 2.5-fold higher odds of recurrent aSBO, supporting careful consideration of OM in appropriately selected patients, regardless of the day of admission.