W. Huett1, N. J. Bruce1, W. C. Beck1, M. K. Kimbrough1, J. Jensen1, M. Sutherland1, R. Robertson1, K. W. Sexton1 1University Of Arkansas For Medical Science,Little Rock, AR, USA
Introduction: The gastrografin challenge (GGC) is a diagnostic tool used to predict the need for surgery in patients with small bowel obstruction (SBO) due to adhesive disease. The GGC was recently implemented into the management of SBO protocol for surgical services at our institution in the 3rd quarter of 2015. We hypothesized that the length of hospital stay would subsequently decrease for patients receiving our updated protocol utilizing the GGC.
Methods: In this retrospective analysis of prospectively collected data, the length of stay for patients admitted to surgery services for SBO before and after implementation of the GGC protocol were measured. The GGC clinical protocol could be found on the division website and was implemented using morning report. If contrast reached the colon at 24 hours, nasogastric tube was removed and diet advanced. If contrast failed to reach the colon at the 24 hour film, operative therapy was recommended. As an additional, temporal control, patients admitted to the medicine service with SBO before and after the surgical services implemented the GGC protocol were examined as well.
Results: A total of 1,468 patients admitted to the surgical services were included in our analysis, as well as 1,026 patients admitted to the medicine service. Implementation of the GGC protocol in the management of adhesive small bowel disease on surgical services reduced the average length of stay by 2 days (7.3± 11.5 days, n=993; vs 5.3 ± 9.6, n=475, p=0.0002). There were 993 patients in the control group, and 475 patients in the intervention arm. There was no difference in mean length of stay for patients admitted to the medicine service with SBO in the time before and after implementation of GGC protocol by surgical services (6.3 ± 11.7 days, n=649 control; 7.0 ± 11.8 days, n=377, p=0.8). In the patients admitted to the surgical services before the protocol, 24% underwent an operation compared to 5% after implementation of the protocol (p<0.0001).
Conclusion: Use of the GGC in the initial, protocol-driven management of adhesive SBO decreases length of stay likely due to a decreased need for operative intervention.