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There is no Financial Penalty for Letting the Sun Set on SBO
*Dean P. Schraufnagel1, *Sean Rajaee1, Frederick H Millham2
1Tufts Medical School, Boston, MA;2Newton Wellesley Hospital, Newton, MA
1. Objective: Todetermine if a financial breakeven point exists in management of adhesive smallbowel obstruction where hospital charges for surgical intervention is exceededby those for hopeful waiting.
2. Design:Retrospective Outcome Study
3. Setting:Administrative Data from the National Inpatient Sample (NIS) a database of 1005acute care hospitals in the US (2009 edition)
4. Patients: We compared median cost of subsequent care for Patients with diagnosis codes foradhesive small bowel obstruction (SBO). For each day from admission to Day 10we compared total charges for patients who were operated upon on that day vs.those who were not.
5. Interventions: Surgery vs. Expectant waiting
6. Main OutcomeMeasure: Median cost of care.
7. Results: 27,759 Patients met inclusion criteria, 5954(21%) had surgery. Of these, 4951 haddata for surgery day. 80% of patientshaving surgery were operated on by the 4th day. Of patients avoiding surgery, 80% weredischarged by day 5. By hospital day 10,91% of patients undergoing surgery had been operated upon, 93% of patients avoidingsurgery had left. The percentage SBO operatedon each day varied from 6% on day of admission to 2.4% on day 10. Median charges for operated patients variedfrom $32, 427 for those operated on day one to $90,344 on day 10. The median charges for patients who were notoperated on that day and not discharged varied from $7,846 on day of admission,to $41,189 on hospital day 10. Median chargesfor further observation never exceed those for operating.
8. Conclusions: There is no added financial cost for observationof SBO over the first 10 days of hospitalization.
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