Impact of Hospital Volume on Outcomes for Laparoscopic Adhesiolysis for Small Bowel Obstruction

Abstract Background Volume-to-outcome data has been studied in several complex surgical procedures, demonstrating improved outcomes at higher volume centers. Laparoscopic lysis of adhesions (LLOA) for small bowel obstruction (SBO) may result in better outcomes, but there is no information on the learning curve for this potentially complex case. This study evaluates the effect of institutional procedural volume on length of stay, outcomes, and costs in laparoscopic lysis of adhesions for small bowel obstructions. Materials and Methods The Nationwide Inpatient Sample (NIS) dataset between 2000 and 2013 was queried for discharges for a diagnosis of SBO involving LLOA in adult patients. Patients with intra-abdominal malignancy and evidence of any other major surgical procedure during hospitalization were excluded. The procedural volume per hospital was calculated over the period, and high volume hospitals were designated as those performing greater than five LLOA per year. Patient characteristics were described by hospital volume status using stratified cluster sampling tabulation and linear regression methods. Length of stay (LOS), cost, and total charges were reported as means with standard deviation and median values. P