The nasogastric tube for adhesional small bowel obstruction: an analysis of treatment effect and outcomes in a tertiary acute general surgical unit

Background: Nasogastric tubes (NGTs) have long been considered standard practice for the management of adhesional small bowel obstructions (ASBOs). However, the evidence to support the routine use of NGTs in ASBO is sparse. This study aims to review outcomes associated with NGT use in a large tertiary centre. Methods: Electronic medical records from patients diagnosed with an ASBO admitted to the acute general surgical unit at John Hunter Hospital between January 2016 and December 2020 were reviewed. Data were analysed to compare outcomes between groups receiving an NGT and those not receiving an NGT. Results: A total of 460 admissions based on 387 patients with ASBO were analysed. An NGT was used in 264 (57%) admission episodes. Higher American Society of Anaesthesiologist scores were seen in the NGT group (p=0.0265). Surgical intervention was required in 94 (36%) patients who had an NGT inserted compared to 13 (7%) patients without an NGT (p<0.0001). The average length of stay was 6.9 days (95% confidence interval [CI], 6.1-7.6) in the NGT group versus 3.2 days (95% CI, 2.7-3.7) in the no-NGT group (p<0.0001). The mean time to surgery was 58.8 hours (95% CI, 47.4-70.3) in the NGT group versus 19.4 hours (95% CI, 12.2-26.5) in the no-NGT group (p=0.0163). Patients in the NGT group were more likely to undergo bowel resection (8% versus 2%; p=0.023). Conclusions: This five-year retrospective study demonstrates that patients with an NGT for ASBO exhibited poorer outcomes than those without one. While these results may reflect a selection bias towards patients with greater disease severity, they highlight the need for further evaluation through a randomised controlled trial.