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Disease Severity and Cost in Adhesive Small Bowel Obstruction.

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Disease Severity and Cost in Adhesive Small Bowel Obstruction. World journal of surgery Hernandez, M. C., Finnesgard, E. J., Shariq, O. A., Knight, A., Stephens, D., Aho, J. M., Kim, B. D., Schiller, H. J., Zielinski, M. D. 2019; 43 (12): 3027-3034

Abstract

Adhesive small bowel obstruction (ASBO) severity has been associated with important clinical outcomes. However, the impact of ASBO severity on hospitalization cost is unknown. The American Association for the Surgery of Trauma (AAST) developed an Emergency General Surgery (EGS) disease severity grading system for ASBO. We stratified patients' ASBO severity and captured hospitalization costs hypothesizing that increased disease severity would correlate with greater costs.This was a single-center study of hospitalized adult patients with SBO during 2015-2017. Clinical data and estimated total cost (direct?+?indirect) were abstracted. AAST EGS grades (I-IV) stratified disease severity. Costs were normalized to the median grade I cost. Univariate and multivariate analyses evaluated the relationship between normalized cost and AAST EGS grade, length of hospital and ICU stay, operative time, and Charlson comorbidity index.There were 214 patients; 119 (56%) were female. AAST EGS grades included: I (62%, n?=?132), II (23%, n?=?49), III (7%, n?=?16), and IV (8%, n?=?17). Relative to grade I, median normalized cost increased by 1.4-fold for grade II, 1.6-fold for grade III, and 4.3-fold for grade IV disease. No considerable differences in patient comorbidity between grades were observed. Pair-wise comparisons demonstrated that grade I disease cost less than higher grades (corrected p?

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