{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:01:47Z","timestamp":1791475307266,"version":"4.3.4"},"reference-count":28,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Adhesive small bowel obstruction (ASBO) is a common and challenging surgical condition. In the absence of peritonitis, bowel ischemia, or clear surgical indicators on CT imaging, the initial management is typically non-operative. While clinical and radiological factors influencing non-operative management (NOM) are well described, the role of age and chronic health conditions remains less well defined. The primary aim of this study was to evaluate the incidence of NOM failure in patients with various comorbidities. Methods: This study utilized data from the National Inpatient Sample to analyze cases of ASBO between 2016 and 2019. Collected data included demographics, diagnosis, presence of chronic health conditions (diabetes mellitus, congestive heart failure, chronic kidney disease, chronic pulmonary diseases, peripheral vascular disease), length of hospital stay, and mortality. Patients were divided into two groups: Group A (18\u201365 years) and Group B (&gt;65 years). We compared demographics comorbidities, NOM failure rates, and mortality between the groups. Univariate analysis was performed to assess age and comorbidities and risk factors for NOM failure in each group, followed by multivariable analysis within each group. Results: A total of 1,611,099 admissions with ASBO were identified in the NIS database; 63.03% were females. The failure rate of NOM in patients without comorbidities was 21%, compared to 26.5% in patients with one or more comorbidities. In Group A, 20% of patients required surgery, compared to 26.2% of patients in Group B (p = 0.001). Conclusions: Being aged over 65 and the presence of chronic health disease, excluding diabetes mellitus, are independent predictors of NOM failure in patients with ASBO. The presence of multiple comorbidities further increases the risk of NOM failure.<\/jats:p>","DOI":"10.3390\/jcm14175989","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T06:26:14Z","timestamp":1756189574000},"page":"5989","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Chronic Comorbidities and Failure of Non-Operative Management in Adhesive Small Bowel Obstruction: Results of Analysis of National Inpatient Data from the United States"],"prefix":"10.3390","volume":"14","author":[{"given":"Gal","family":"Malkiely","sequence":"first","affiliation":[{"name":"Division of Surgery, Hillel Yaffe Medical Center, Hadera 38100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Paran","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Schneider Children\u2019s Medical Center, Petah Tikva 4920235, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miri","family":"Elgabsi","sequence":"additional","affiliation":[{"name":"Division of Surgery, Hillel Yaffe Medical Center, Hadera 38100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"Kessel","sequence":"additional","affiliation":[{"name":"Division of Surgery, Hillel Yaffe Medical Center, Hadera 38100, Israel"},{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1177\/1457496920982763","article-title":"Adhesive Small Bowel Obstruction and the six w\u2019s: Who, How, Why, When, What, and Where to diagnose and operate?","volume":"110","author":"Podda","year":"2021","journal-title":"Scand. J. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1016\/j.surg.2015.11.016","article-title":"Long-term impact of adhesions on bowel obstruction","volume":"159","author":"Strik","year":"2016","journal-title":"Surgery"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.amjsurg.2018.10.035","article-title":"Risk of adhesive bowel obstruction after abdominal surgery. A national cohort study of 665,423 Danish women","volume":"217","author":"Norrbom","year":"2019","journal-title":"Am. J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e160480","DOI":"10.1001\/jamasurg.2016.0480","article-title":"Use of National Burden to Define Operative Emergency General Surgery","volume":"151","author":"Scott","year":"2016","journal-title":"JAMA Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"f5588","DOI":"10.1136\/bmj.f5588","article-title":"Burden of adhesions in abdominal and pelvic surgery: Systematic review and met-analysis","volume":"347","author":"Broek","year":"2013","journal-title":"BMJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1177\/000313481508100627","article-title":"Adhesive Small Bowel Obstruction: Early Operative versus Observational Management","volume":"81","author":"Bauer","year":"2015","journal-title":"Am. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"8628","DOI":"10.1007\/s00464-023-10282-9","article-title":"Predictive factors for operative intervention and ideal length of non-operative trial in adhesive small bowel obstruction","volume":"37","author":"Ramanathan","year":"2023","journal-title":"Surg. Endosc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1097\/TA.0000000000002150","article-title":"Management of adhesive small bowel obstruction: A distinct paradigm shift in the United States","volume":"86","author":"Matsushima","year":"2019","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/TA.0000000000000491","article-title":"A protocol for the management of adhesive small bowel obstruction","volume":"78","author":"Loftus","year":"2015","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/j.jss.2024.12.032","article-title":"Evaluation of the Management Strategies for Adhesive Small-Bowel Obstruction","volume":"306","author":"Stegall","year":"2025","journal-title":"J. Surg. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1097\/SLA.0b013e31826f4969","article-title":"Adhesiolysis-Related Morbidity in Abdominal Surgery","volume":"258","author":"Broek","year":"2013","journal-title":"Ann. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1007\/s00423-016-1414-3","article-title":"Risk factors for future repeat abdominal surgery","volume":"401","author":"Strik","year":"2016","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1007\/s00261-020-02800-3","article-title":"Small bowel obstruction and intestinal ischemia: Emphasizing the role of MDCT in the management decision process","volume":"47","author":"Scaglione","year":"2020","journal-title":"Abdom. Imaging"},{"key":"ref_14","first-page":"26","article-title":"Adhesive Small Bowel Obstruction: Predictive Factors of Lack of Response in Conservative Management with Gastrografin","volume":"33","author":"Barber","year":"2015","journal-title":"Dig. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.4240\/wjgs.v15.i6.1116","article-title":"Predictors for success of non-operative management of adhesive small bowel obstruction","volume":"15","author":"Ng","year":"2023","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"893","DOI":"10.2147\/TCRM.S496629","article-title":"Clinical and Radiological Factors Associated with Nonoperative Management Failure for Small Bowel Obstruction: A Retrospective Study from a Resource-Limited Setting","volume":"20","author":"Alyhari","year":"2024","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s13017-018-0185-2","article-title":"Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group","volume":"13","author":"Krielen","year":"2018","journal-title":"World J. Emerg. Surg."},{"key":"ref_18","first-page":"100185","article-title":"Associated factors with non operative management failure in bowel obstruction","volume":"16","author":"Moreno","year":"2024","journal-title":"Surg. Open Dig. Adv."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1111\/ans.14556","article-title":"Current management of adhesive small bowel obstruction","volume":"88","author":"Truskett","year":"2018","journal-title":"ANZ J. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00384-023-04512-8","article-title":"Management of adhesive small bowel obstruction: The results of a large retrospective study","volume":"38","author":"Maienza","year":"2023","journal-title":"Int. J. Color. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3861","DOI":"10.1007\/s00330-023-10421-9","article-title":"Prognostic factors to identify resolution of small bowel obstruction without need for operative management: Systematic review","volume":"34","author":"Eze","year":"2023","journal-title":"Eur. Radiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1007\/s00330-020-07406-3","article-title":"Non-strangulated adhesive small bowel obstruction: CT findings predicting outcome of conservative treatment","volume":"31","author":"Kim","year":"2020","journal-title":"Eur. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1007\/s00268-023-06906-9","article-title":"The Angers CT Score is a Risk Factor for the Failure of the Conservative Management of Adhesive Small Bowel Obstruction: A Prospective Observational Multicentric Study","volume":"47","author":"Paisant","year":"2023","journal-title":"World J. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jss.2022.05.015","article-title":"Predicting the Need for Surgery in Uncomplicated Adhesive Small Bowel Obstruction: A Scoring Tool","volume":"279","author":"Maraux","year":"2022","journal-title":"J. Surg. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1016\/j.suc.2018.05.007","article-title":"Small Bowel Obstruction","volume":"98","author":"Bower","year":"2018","journal-title":"Surg. Clin. N. Am."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"223","DOI":"10.3393\/ac.2019.09.30","article-title":"Factors Predicting the Need for Early Surgical Intervention for Small Bowel Obstruction","volume":"36","author":"Cho","year":"2020","journal-title":"Ann. Coloproctology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1080\/00365521.2021.1921256","article-title":"Adhesive small bowel obstruction in elderly patients: A single-center analysis of treatment strategies and clinical outcomes","volume":"56","author":"Quero","year":"2021","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_28","first-page":"974","article-title":"Ileus in the critically ill: Causes, treatment and prevention","volume":"86","author":"Huet","year":"2020","journal-title":"Minerva Anestesiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/5989\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:32:17Z","timestamp":1760034737000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/5989"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,25]]},"references-count":28,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14175989"],"URL":"https:\/\/doi.org\/10.3390\/jcm14175989","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,25]]}}}