Abstract
Introduction
Variation in surgical management exists nationally. We hypothesize that geographic
variation exists in adhesive small bowel obstruction (aSBO) management.
Materials and methods
A retrospective analysis of a national commercial insurance claims database (MarketScan)
sample (2017-2019) was performed in adults with hospital admission due to aSBO. Geographic
variation in rates of surgical intervention for aSBO was evaluated by state and compared
to a risk-adjusted national baseline using a Bayesian spatial rates Poisson regression
model. For individual-level analysis, patients were identified in 2018, with 365-d
look back and follow-up periods. Logistic regression was performed for individual-level
predictors of operative intervention for aSBO.
Results
Two thousand one hundred forty-five patients were included. State-level analysis revealed
rates of operative intervention for aSBO were significantly higher in Missouri and
lower in Florida. On individual-level analysis, age (P < 0.01) and male sex (P < 0.03) but not comorbidity profile or prior aSBO, were negatively associated with
undergoing operative management for aSBO. Patients presenting in 2018 with a history
of admission for aSBO the year prior experienced a five-fold increase in odds of representation
(odds ratio: 5.4, 95% confidence interval: 3.1–9.6) in 2019. Patients who received
an operation for aSBO in 2018 reduced the odds of readmission in the next year by
77% (odds ratio: 0.23, 95% confidence interval: 0.1–0.5). The volume of operations
performed within a state did not influence readmission.
Conclusions
Surgical management of aSBO varies across the continental USA. Operative intervention
is associated with decreased rates of representation in the following year. These
data highlight a critical need for standardized guidelines for emergency general surgery
patients.
Keywords
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References
- Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994.J Am Coll Surg. 1998; 186: 1-9
- The inpatient burden of abdominal and gynecological adhesiolysis in the US.BMC Surg. 2011; 11: 13
- The public health burden of emergency general surgery in the United States.J Trauma Acute Care Surg. 2014; 77: 202-208
- Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group.World J Emerg Surg. 2018; 13: 24
- Hospital-level variation in the management and outcomes of patients with adhesive small bowel obstruction.Ann Surg. 2021; 274: e1063-e1070
- Variation in the Care of Surgical Conditions.A Dartmouth Atlas of Health Care Series., Lebanon, NH2014
- Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly.J Bone Jt Surg A. 2011; 93: 121-131
- Understanding of regional variation in the use of surgery.Lancet. 2013; 382: 1121-1129
- Physician beliefs and patient preferences: a new look at regional variation in health care spending.Am Econ J Econ Policy. 2019; 11: 192-221
- Impact of postcolectomy adhesion-related complications on healthcare utilization.Clin Outcomes Res. 2018; 10: 761-771
- Impact of operative management on recurrence of adhesive small bowel obstruction: a longitudinal analysis of a statewide database.J Am Coll Surg. 2020; 230: 544-551.e1
- Association of surgical intervention for adhesive small-bowel obstruction with the risk of recurrence.JAMA Surg. 2019; 154: 413-420
- Comorbidity measures for use with administrative data.Med Care. 1998; 36: 8-27
- A modification of the elixhauser comorbidity measures into a point system for hospital death using administrative data.Med Care. 2009; 47: 626-633
- Statistics for spatio-temporal data.(Available at:)https://www.wiley.com/en-us/Statistics+for+Spatio+Temporal+Data-p-9780471692744Date: 2021Date accessed: November 27, 2021
- Likelihood-based estimation for Gaussian MRFs.Stat Methodol. 2005; 2: 1-16
- Spatial interaction and the statistical analysis of lattice systems.J R Stat Soc. 1974; 36: 192-236
- Standards for statistical models used for public reporting of health outcomes: an American heart association scientific statement from the quality of care and outcomes Research interdisciplinary writing group.Circulation. 2006; 113: 456-462
- How pooling fragmented healthcare encounter data affects hospital profiling.Am J Manag Care. 2015; 21: 129-138
- Programming with models: writing statistical algorithms for general model structures with NIMBLE.J Comput Graph Stat. 2017; 26: 403-413
- Definition of Emergency General Surgery (EGS) and its burden on the society.in: Brown C. Inaba K. Martin M. Salim A. Emergency General Surgery. Springer, Cham2019
- Efficiency of care and cost for common emergency general surgery conditions: comparison by surgeon training and practice.Surgery. 2018; 164: 651-656
- Dartmouth atlas of health care.(Available at:)
- Shared decision making in surgery: a scoping review of patient and surgeon preferences.BMC Med Inform Decis Mak. 2020; 20: 190https://doi.org/10.1186/s12911-020-01211-0
- Determining the need for hip and knee arthroplasty: the role of clinical severity and patients’ preferences.Med Care. 2001; 39: 206-216
- Relationship between regional per capita Medicare expenditures and patient perceptions of quality of care.JAMA. 2008; 299: 2406-2412
- Are regional variations in end-of-life care intensity explained by patient preferences?: a Study of the US Medicare Population.Med Care. 2007; 45: 386-393
- Surgery for adhesive small-bowel obstruction is associated with improved long-term survival mediated through recurrence prevention: a population-based, propensity-matched analysis.J Trauma Acute Care Surg. 2019; 87: 636-644
- The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care.Ann Intern Med. 2003; 138: 273-287
- Discretionary decision making by primary care physicians and the cost of U.S. Health care.Health Aff. 2008; 27: 813-823
- Population level analysis of adhesive small bowel obstruction: sustained advantage of a laparoscopic approach.Ann Surg. 2020; 271: 898-905
- Application of a uniform anatomic grading system to measure disease severity in eight emergency general surgical illnesses.J Trauma Acute Care Surg. 2014; 77: 705-708
- Achieving goal-concordant care: a conceptual model and approach to measuring serious illness communication and its impact.J Palliat Med. 2018; 21: S17-S27
- Inner deliberations of surgeons treating critically-ill emergency general surgery patients: a qualitative analysis.Ann Surg. 2021; 274: 1081-1088
Article info
Publication history
Published online: February 06, 2023
Accepted:
December 25,
2022
Received in revised form:
October 6,
2022
Received:
July 26,
2022
Identification
Copyright
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