Using gastrografin to manage adhesive small bowel obstruction: A nonrandomized controlled study with historical controls

Background: A standardized protocol for managing adhesive small bowel obstruction using diatrizoate meglumine and diatrizoate sodium (Gastrografin) was implemented at Vancouver General Hospital. Our study assessed whether this protocol improved the quality of patient care. Methods: A nonrandomized controlled study was conducted. Two groups of patients were studied: a preimplementation group (historical control) and a postimplementation group that received the Gastrografin protocol. The primary outcome was length of hospital stay. Secondary outcomes included rate of successful conservative manage-ment, need for surgery, time to resolution of the obstruction, time to surgery, readmission to hospi-tal, rate of complications or mortality, and patient satisfaction. Results: The study included 122 patients (n = 82 preimplementation; n = 40 postimplementation). In the postimplementation group, length of hospital stay was shortened (adjusted mean difference:-3.209 days; 95% CI,-5.772 to-0.645; P = 0.015), successful conservative management was higher (odds ratio: 3.354; 95% CI, 1.129-12.600; P = 0.044), and need for surgery was lower (odds ratio: 0.237; 95% CI, 1.129-12.600; P = 0.034) compared with the preimplementation group. Patients in the post-implementation group were generally satisfied with their care. Conclusions: The implementation of a standardized protocol using Gastrografin for managing adhesive small bowel obstruction was associated with improved quality of patient care.