Survey of Diagnostic and Management Practices in Small Bowel Obstruction: Individual and Generational Variation Despite Practice Guidelines

Introduction: Small bowel obstruction (SBO) is among the most common disorders managed by acute care surgeons. Despite extensive publications and an Eastern Association for the Surgery of Trauma (EAST) practice management guideline (PMG), there is no universally accepted approach to the diagnosis and management of SBO. We conducted a survey of trauma surgeons to elucidate their current SBO practice patterns. Methods: A self-report survey of SBO diagnosis and management practices in adults was designed and distributed by email to American Association for the Surgery of Trauma member surgeons who directly cared for SBO patients. Responses were analyzed with descriptive statistics and Chi-Square test of independence at α=.05. Results: There were 201 useable surveys: 53% ≥50 years, 77% male, 77% at Level I trauma centers. Formal hospital SBO management guidelines were reported by only 35.8%. CT scan was the only diagnostic exam listed as “essential” by most respondents (82.6%). After NG decompression, 153 (80.1%) would always/frequently administer gastrografin challenge (GC). There were notable age differences in approach. Surgeons 30-49 years were less likely to deem plain abdominal films as ‘essential’ (16.0% vs 40.2%; p < .001), but more likely to require CT scan (88.3% vs 77.6%; p = .045) for diagnosis, and to always/frequently administer GC (84.0% vs 69.2%; p < .01) compared with those ≥50 years. Conclusion: Among respondents in this convenience sample, there is significant variation in the diagnosis and management of SBO despite a specific EAST PMG. Novel age differences in responses were observed and prompt further evaluation. Additional research is needed to determine whether variation in practice patterns is widespread and affects patient outcomes.