Variability in the Management of Adhesive Small Bowel Obstruction in Children

Abstract Background This study assessed inter-hospital variability in operative-vs-nonoperative management of pediatric adhesive small bowel obstruction (ASBO). Methods A multi-institutional retrospective study was performed examining patients 1–21 years-of-age presenting with ASBO from 2010–2019 utilizing the P ediatric H ealth I nformation S ystem. Multivariable mixed-effects logistic regression was performed assessing inter-hospital variability in operative-vs-nonoperative management of ASBO. Results Among 6,410 pediatric ASBO admissions identified at 46 hospitals, 3,239 (50.5%) underwent surgery during that admission. The hospital-specific rate of surgery ranged from 35.3% (95%CI: 28.5%–42.6%) to 74.7% (66.3%–81.6%) in the unadjusted model (p Conclusions Rates of surgical intervention for ASBO vary significantly across tertiary children's hospitals in the United States. The variability was independent of patient and hospital characteristics and is likely due to practice variation.