M. C. Hernandez1, E. J. Finnesgard1, M. D. Ray-Zack1, O. A. Shariq1, D. Stephens1, J. M. Aho1, A. W. Knight1, N. N. Haddad1, B. D. Kim1, H. J. Schiller1, M. D. Zielinski1 1Mayo Clinic,Surgery,Rochester, MN, USA
Introduction:
Adhesive small bowel obstruction (ASBO) severity is associated with several 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) grading system for ASBO. We stratified patients’ ASBO severity and captured hospitalization costs hypothesizing that increased disease severity would correlate with greater costs.
Methods:
This was a single-center study of hospitalized adult patients with SBO during 2015-2017. Clinical data and total costs (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.
Results:
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 were observed by grade. Pair-wise comparisons demonstrated that grade I disease cost less than higher grades (corrected p<0.001). Non-operative management was associated with lower normalized cost compared to operative management (1.1 vs 4.5, p<0.0001). In patients failing non-operative management and required an operation, normalized cost was increased 7.2 fold. Collectively, the AAST EGS grade correlated well with cost (Spearman’s ρ=0.7, p<0.001). After adjustment for covariates, regression demonstrated a persistent relationship between AAST EGS grade and cost, Table.
Conclusion:
Increasing ASBO severity is independently associated with greater costs. Efforts to identify and mitigate costs associated with this burdensome disease are warranted.
