Early operative management in patients with adhesive small bowel obstruction: population‐based cost analysis
| Autor: | Paul J. Karanicolas, Petros Pechlivanoglou, Ramy Behman, Avery B. Nathens, N Look Hong, James J. Jung |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Databases Factual Cost effectiveness Population lcsh:Surgery Tissue Adhesions 03 medical and health sciences 0302 clinical medicine Recurrence Intestine Small Humans Medicine 030212 general & internal medicine General Propensity Score Adverse effect education Aged Retrospective Studies Ontario First episode education.field_of_study Cost–benefit analysis business.industry 030208 emergency & critical care medicine Retrospective cohort study Original Articles General Medicine lcsh:RD1-811 Middle Aged medicine.disease Quality-adjusted life year Hospitalization Bowel obstruction Logistic Models Treatment Outcome Emergency medicine Costs and Cost Analysis Original Article Female Quality-Adjusted Life Years business Intestinal Obstruction |
| Zdroj: | BJS Open, Vol 4, Iss 5, Pp 914-923 (2020) BJS Open |
| ISSN: | 2474-9842 |
| Popis: | Background Adhesive small bowel obstruction (aSBO) is a potentially recurrent disease. Although non‐operative management is often successful, it is associated with greater risk of recurrence than operative intervention, and may have greater downstream morbidity and costs. This study aimed to compare the current standard of care, trial of non‐operative management (TNOM), and early operative management (EOM) for aSBO. Methods Patients admitted to hospital between 2005 and 2014 in Ontario, Canada, with their first episode of aSBO were identified and propensity‐matched on their likelihood to receive EOM for a cost–utility analysis using population‐based administrative data. Patients were followed for 5 years to determine survival, recurrences, adverse events and inpatient costs to the healthcare system. Utility scores were attributed to aSBO‐related events. Cost–utility was presented as the incremental cost‐effectiveness ratio (ICER), expressed as Canadian dollars per quality‐adjusted life‐year (QALY). Results Some 25 150 patients were admitted for aSBO and 3174 (12·6 per cent) were managed by EOM. Patients managed by TNOM were more likely to experience recurrence of aSBO (20·9 per cent versus 13·2 per cent for EOM; P This population‐based cost–utility analysis compared early operative management (EOM) for adhesive small bowel obstruction (SBO) to the current standard of care of a trial of non‐operative management. Although EOM was more costly, it was associated with a significantly lower risk of recurrence and reduced exposure to the morbidity and costs associated with multiple admissions for adhesive SBO. With longer follow‐up, EOM becomes increasingly cost‐effective, and crosses published willingness‐to‐pay thresholds within 5 years of the first admission. Early operative management in small bowel occlusion |
| Databáze: | OpenAIRE |
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