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Time for Change: Patients with Adhesive Small Bowel Obstruction Should Be Managed by a Primary Surgical Team
Christopher T Aquina*, Christian P Probst*, Adan Z Becerra*, Bradley J Hensley*, Zhaomin Xu*, James C Iannuzzi*, Katia Noyes*, John R.T. Monson, Fergal J Fleming*
University of Rochester Medical Center, Rochester, NY

OBJECTIVE(S):
Adhesive-small bowel obstruction (SBO) is associated with high healthcare utilization. Many patients are admitted to hospitalists perhaps because most patients are managed non-operatively. However, outcome comparisons between primary medical and surgical services have been limited to single-institution studies. This study evaluates the impact of admission to primary medical versus surgical services on healthcare utilization and outcomes for adhesive-SBO using a population-based dataset.
METHODS:
New York’s Statewide Planning and Research Cooperative System was queried for unscheduled adhesive-SBO admissions from 2002-2013. Propensity-adjusted mixed-effects analyses assessed the association between primary service and healthcare utilization and outcomes for adhesive-SBO admissions.
RESULTS:
Among 107,603 admissions (78% non-operative, 22% operative), 43% were admitted to medical services and 57% were admitted to surgical services. After controlling for patient, physician, and hospital-level factors, primary management by medical services was independently associated with a delay in time to surgical intervention, longer length of stay, greater inpatient costs, and higher 30-day mortality and readmission rates (Table). Using adjusted population attributable risk estimates, 1.3 million inpatient days and .2 billion could be saved and 2,500 deaths and 30,000 readmissions avoided in the U.S. annually if all adhesive-SBO patients were admitted to surgical services.
CONCLUSIONS:
Admission of patients with adhesive-SBO to medical teams is associated with higher healthcare costs and worse outcomes. Policies favoring primary admission to surgical services may greatly reduce costs and improve outcomes.


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