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Introduction
Best practices encourage early diagnosis and treatment of bowel obstruction due to abdominal wall hernias. Delay in care is associated with incarceration and potential strangulation. The purpose of this study was to compare outcomes of bowel obstruction due to abdominal wall hernias in elderly patients living in long-term care facilities (LCF).
Methods
The Nationwide Inpatient Sample for 2009 was used to identify hospitalizations due to bowel obstruction with abdominal wall hernias (age > 65). Outcomes of gangrenous bowel and bowel resection were compared based on whether the patients were transferred from LCF. Economic analysis included length of stay (LOS) and total hospital charges (THC). Multivariate logistic regression analysis was used to identify independent risk factors for gangrenous bowel or bowel resection.
Results
30,828 bowel obstruction with hernia cases were identified. Patients living in LCF were more likely to present with gangrenous bowel (5.8% vs 2.2%, OR 2.734, P=0.008). LCF patients were also more likely to require bowel resection (24.5% vs 15.7%, OR 1.750 , P=0.003). Mortality was significantly higher for the LFC patients (13.0% vs 3.7%, OR 3.906, P<0.001). Gangrenous bowel or bowel resection resulted in increased median LOS (9 days vs 4 days) and mean THC ($88,611 vs $44,987, P<0.001). Multivariate logistic regression analysis adjusting for Medicare coverage, poorest median income, urban location, psychiatric disorders, and depression found LCF residence to be an independent risk factor for gangrenous bowel or bowel resection (OR 2.766, P<0.001).
Conclusion
Patients with bowel obstruction due to abdominal hernias living in LCF are at a significantly increased risk of developing gangrenous bowel and requiring bowel resection. Potential delay in diagnosis may contribute to delay in presentation resulting in significant morbidity and mortally.