1
|
Branche C, Chervu N, Porter G, Vadlakonda A, Sakowitz S, Ali K, Mallick S, Benharash P. The impact of rurality on racial disparities in costs of bowel obstruction treatment. Surg Open Sci 2024; 20:27-31. [PMID: 38873333 PMCID: PMC11170271 DOI: 10.1016/j.sopen.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024] Open
Abstract
Background Black race has been associated with increased resource utilization after operation for small bowel obstruction (SBO). While prior literature has similarly demonstrated differences between urban and rural institutions, limited work has defined the impact of rurality on resource utilization by race. Methods The 2016-2020 National Inpatient Sample was used to identify adults undergoing adhesiolysis after non-elective admission for SBO. The primary endpoint was hospitalization costs. Additional outcomes included surgical delay (≥ hospital day 3), length of stay (LOS), and nonhome discharge. Regression models were developed to identify the impact of Black race and rurality on the outcomes of interest with an interaction term to examine the incremental association of Black race on rurality. Results Of an estimated 132,390 patients, 11.4 % were treated at an annual average of 377 rural hospitals (18.5 % of institutions). After adjustment, rural hospitals had higher costs (β + $4900, 95 % Confidence Interval [CI] [4200, 5700]), compared to others. However, rurality was associated with reduced odds of surgical delay (Adjusted Odds Ratio [AOR] 0. 76, CI[0.69, 0.85]), decreased LOS (β -1.66 days, CI[-1.99, -1.36]), and nonhome discharge (AOR 0.78, CI[0.70, 0.87]). While White patients experienced significant cost reductions at urban centers ($26,100 [25,800-26,300] vs $31,000 [30,300-31,700]), this was not noted for Black patients ($30,100 [29,400-30,700] vs $30,800 [29,300-32,400]). Conclusions We found that Black patients do not benefit from the same cost protection afforded by urban settings as White patients after operative SBO admission. Future work should focus on setting-specific interventions to address drivers of disparities within each community.
Collapse
Affiliation(s)
- Corynn Branche
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nikhil Chervu
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA, USA
| | - Giselle Porter
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Amulya Vadlakonda
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sara Sakowitz
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Konmal Ali
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Saad Mallick
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peyman Benharash
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA, USA
| |
Collapse
|
2
|
Sarani B, Paspulati RM, Hambley J, Efron D, Martinez J, Perez A, Bowles-Cintron R, Yi F, Hill S, Meyer D, Maykel J, Attalla S, Kochman M, Steele S. A multidisciplinary approach to diagnosis and management of bowel obstruction. Curr Probl Surg 2018; 55:394-438. [PMID: 30526888 DOI: 10.1067/j.cpsurg.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/11/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Babak Sarani
- Center for Trauma and Critical Care, George Washington University School of Medicine, Washington, DC.
| | | | - Jana Hambley
- Department of Trauma and Acute Care Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Efron
- Division of Acute Care Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jose Martinez
- Division of Minimally Invasive Surgery, Minimally Invasive Surgery/Flexible Endoscopy Fellowship Program, University of Miami Miller School of Medicine, Miami, FL
| | - Armando Perez
- University of Miami Miller School of Medicine, Miami, FL
| | | | - Fia Yi
- Brooke Army Medical Center, San Antonio, TX
| | - Susanna Hill
- University of Massachusetts Medical Center, Worcester, MA
| | - David Meyer
- Division of Colon and Rectal Surgery, University of Massachusetts Medical Center, Worcester, MA
| | - Justin Maykel
- Division of Colon and Rectal Surgery, University of Massachusetts Medical Center, Worcester, MA
| | - Sara Attalla
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Michael Kochman
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | |
Collapse
|
3
|
Sazhin AV, Tyagunov AE, Larichev SE, Lebedev IS, Makhuova GB, Marchenko IP, Polushkin VG, Tyagunov AA, Sazhin IV, Nechay TV, Ivakhov GB, Titkova SM, Anurov MV, Gasanov MM, Kolygin AV, Mirzoyan AT, Glagolev NS, Kurashinova LS. [Optimal time of surgery for acute adhesive small bowel obstruction]. Khirurgiia (Mosk) 2018:24-30. [PMID: 29560955 DOI: 10.17116/hirurgia2018324-30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To define optimal terms of surgery for acute adhesive non-strangulatory small bowel obstruction. MATERIAL AND METHODS The analysis included 703 publications from e-LIBRARI.RU (342 works) and NCBI (361 works) databases for acute adhesive intestinal obstruction. The vast majority of articles presented retrospective analysis of single-center experience. RESULTS It has been established that short course of medication is predominantly used for acute adhesive intestinal obstruction in the Russian Federation. International studies point 2-5 days for conservative treatment. The advantages and disadvantages of short and long courses of medication were analyzed. Therefore, multicenter, prospective, randomized trial 'Comparison of early operative treatment (12-hour medication) and long-term conservative treatment (48 hours) for acute adhesive small bowel obstruction' (COTACSO) was planned and registered (Unique Protocol ID: 14121729). The study protocol involves clinical, laboratory and instrumental exclusion of strangulation, randomization and conservative treatment of 2 groups of patients for 12 and 48 hours. Patients will undergo surgical interventions if obstruction will be present by that date. The main endpoint is mortality rate in both groups. The end of the study is December 2020.
Collapse
Affiliation(s)
- A V Sazhin
- Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - A E Tyagunov
- Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia; Bauman Municipal Clinical Hospital #29 of Moscow Healthcare Department, Moscow, Russia
| | - S E Larichev
- Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - I S Lebedev
- Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia; Pirogov Municipal Clinical Hospital #1 of Moscow Healthcare Department, Moscow, Russia
| | - G B Makhuova
- Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia; Buyanov Municipal Clinical Hospital #12 of Moscow Healthcare Department, Moscow, Russia
| | - I P Marchenko
- Bauman Municipal Clinical Hospital #29 of Moscow Healthcare Department, Moscow, Russia
| | - V G Polushkin
- Sechenov First Moscow State Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - A A Tyagunov
- Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - I V Sazhin
- Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia; Buyanov Municipal Clinical Hospital #12 of Moscow Healthcare Department, Moscow, Russia
| | - T V Nechay
- Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - G B Ivakhov
- Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - S M Titkova
- Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - M V Anurov
- Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - M M Gasanov
- Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - A V Kolygin
- Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia; Bauman Municipal Clinical Hospital #29 of Moscow Healthcare Department, Moscow, Russia
| | - A T Mirzoyan
- Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia; Bauman Municipal Clinical Hospital #29 of Moscow Healthcare Department, Moscow, Russia
| | - N S Glagolev
- Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia; Bauman Municipal Clinical Hospital #29 of Moscow Healthcare Department, Moscow, Russia
| | - L S Kurashinova
- Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| |
Collapse
|
4
|
Leclercq RMFM, Van Barneveld KWY, Schreinemacher MHF, Assies R, Twellaar M, Bouvy ND, Muris JWM. Postoperative abdominal adhesions and bowel obstruction. A survey among Dutch general practitioners. Eur J Gen Pract 2015; 21:176-82. [DOI: 10.3109/13814788.2015.1055466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
|
5
|
Eren T, Boluk S, Bayraktar B, Ozemir IA, Yildirim Boluk S, Tombalak E, Alimoglu O. Surgical indicators for the operative treatment of acute mechanical intestinal obstruction due to adhesions. Ann Surg Treat Res 2015; 88:325-33. [PMID: 26029678 PMCID: PMC4443264 DOI: 10.4174/astr.2015.88.6.325] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 11/06/2014] [Accepted: 12/03/2014] [Indexed: 12/18/2022] Open
Abstract
Purpose Our aim was to investigate the predictive factors indicating strangulation, and the requirement for surgery in patients with acute mechanical intestinal obstruction due to adhesions. Methods This study retrospectively evaluated the records of patients with adhesive acute mechanical intestinal obstruction. The surgical treatment (group S), conservative treatment (group C), intraoperative bowel ischemia (group I), and intraoperative adhesion only (group A) groups were statistically evaluated according to the diagnostic and surgical parameters. Results The study group of 252 patients consisted of 113 women (44.8%), and 139 men (55.2%). The mean age was 62.79 ± 18.08 years (range, 20-98 years). Group S consisted of 50 patients (19.8%), and 202 (80.2%) were in group C. Group I consisted of 19 patients (38%), where as 31 (62%) were in group A. In group S, the prehospital symptomatic period was longer, incidence of fever was increased, and elevated CRP levels were significant (P < 0.05). Plain abdominal radiography, and abdominal computerized tomography were significantly sensitive for strangulation (P < 0.05). The elderly were more prone to strangulation (P < 0.05). Fever, rebound tendernes, and urea & creatinine levels were significantly higher in the presence of strangulation (P < 0.05, P < 0.05, and P < 0.05, consecutively). Conclusion Fever, rebound tenderness, urea & creatinine levels, plain abdominal radiography, and abdominal computerized tomography images were important indicators of bowel ischemia. Longer prehospital symptomatic period was related with a tendency for surgical treatment, and the elderly were more prone to strangulation. CRP detection was considered to be useful for the decision of surgery, but not significantly predictive for strangulation.
Collapse
Affiliation(s)
- Tunc Eren
- Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Salih Boluk
- Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Baris Bayraktar
- Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Ibrahim Ali Ozemir
- Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Sumeyra Yildirim Boluk
- Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Ercument Tombalak
- Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Orhan Alimoglu
- Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| |
Collapse
|
6
|
Abstract
Acute obstruction of the gastrointestinal or biliary tract represents a common problem for acute care surgeons. It is with appropriate clinical evaluation, planning, and physical examination follow-up that acute care surgeons are able to appropriately diagnose, manage, and resolve this difficult group of surgical problems and minimize the morbidity associated with each.
Collapse
Affiliation(s)
- Jason Sperry
- University of Pittsburgh Medical Center, Suite F1268 PUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | | |
Collapse
|
7
|
Chu DI, Gainsbury ML, Howard LA, Stucchi AF, Becker JM. Early versus late adhesiolysis for adhesive-related intestinal obstruction: a nationwide analysis of inpatient outcomes. J Gastrointest Surg 2013; 17:288-97. [PMID: 22914981 DOI: 10.1007/s11605-012-1953-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 06/24/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Classical teaching advocates watchful waiting for 2 days before operating on adhesive-related intestinal obstructions (AIOs). Our aim was to compare the clinical and cost outcomes of early versus late adhesiolysis for AIOs. DESIGN Patients undergoing adhesiolysis for AIOs from the 2007 Nationwide Inpatient Sample were stratified to early (≤2 days from admission) vs. late (>2 days) adhesiolysis. The primary outcome was in-hospital mortality and secondary outcomes were post-operative complications (POCs), post-operative length of stay (PLOS), and in-hospital cost. RESULTS From 5,443 patients who underwent adhesiolysis for AIOs, 53 and 47 % underwent early and late adhesiolysis, respectively. Late adhesiolysis patients were older (65.0 vs. 60.1 years) and more co-morbid compared to the early group (p < 0.05). After adjustment with propensity score methods, late adhesiolysis patients had no difference in mortality (odds ratio [OR] 0.95, 95%-confidence intervals [CI] 0.67-1.36, p = 0.79) or POCs (OR 1.01, 95%CI 0.89-1.14, p = 0.91) compared to the early group, but had 9.8 % increased PLOS and 41.9 % increased in-hospital cost (p < 0.001). CONCLUSIONS The 2-day limit of watchful waiting is not associated with increased mortality or POCs for those patients undergoing adhesiolysis for an AIO. Late adhesiolysis, however, was associated with significantly increased PLOS and in-hospital cost compared to early adhesiolysis.
Collapse
Affiliation(s)
- Daniel I Chu
- Department of Surgery, Boston University Medical Center, Boston, MA, USA.
| | | | | | | | | |
Collapse
|