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2010 Annual Meeting Abstracts

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Late Adhesiolysis For Adhesive Bowel Obstruction (ABO) Is Safe But Increases Post-Operative Length of Stay and In-hospital Cost Compared To Early Adhesiolysis: A Nationwide Analysis of Inpatient Outcomes.
*Daniel I Chu, *Jeremy T. Hetzel, *Melanie L. Gainsbury, *Lauren A. Howard, *Arthur F. Stucchi, James M. Becker
Boston University School of Medicine, Boston, MA

Objective: To compare the clinical and cost outcome for patients undergoing early vs. late adhesiolysis for ABOs in a nationwide, representative inpatient database.
Design: Patients undergoing adhesiolysis for ABO were identified from the 2007 National Inpatient Sample (NIS) database and stratified to early (<=2days from admission) vs. late (>2d) adhesiolysis before undergoing outcome analysis.
Setting: The 2007 NIS is the largest publicly-available inpatient database sponsored by the Agency for Healthcare Research and Quality (AHRQ) as part of the Healthcare Cost and Utilization Project (HCUP). The NIS represents a 20-percent stratified sample of inpatients from all U.S. community hospitals.
Patients: From 8,034,632 patients included in the 2007 NIS, 5,454 patients were identified who underwent adhesiolysis for ABO.
Interventions: No interventions.
Outcome: The primary outcome was in-hospital mortality and secondarily all post-operative complications (POC), length of stay (LOS), post-operative LOS (PLOS) and in-hospital cost.
Results: From 5,454 patients who underwent adhesiolysis for ABO, 53.2% and 46.8% underwent early vs. late adhesiolysis, respectively. Early adhesiolysis patients were younger (60.1 vs. 65.0yrs, p<0.001), more privately insured (41.5 vs. 34.0%, p<0.001) and had 13 co-morbidities with lower frequencies compared to late adhesiolysis patients (p<0.05). After covariate adjustment with multivariable regression models, no difference in mortality or POC was observed between early vs. late adhesiolysis (odds ratio[OR]=1.05, p=0.10 and OR=1.02, p=0.16, respectively). LOS and PLOS were reduced by 4.13 and 0.53 days, respectively, with early vs. late adhesiolysis (p<0.001). In-hospital cost increased by $19,409 dollars for each patient undergoing late vs. early adhesiolysis (p<0.001).
Conclusions: This nationwide study shows that while it may be safe to delay surgery for patients with ABO, late adhesiolysis significantly increases PLOS and in-hospital cost.

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