Small bowel obstruction due to postoperative adhesions: treatment patternsand associated costs in 110 hospital admissions

The workload and costs of the emergency admissions and treatment of adhesiv e small bowel obstruction (ASBO) are unclear. This review details and costs the admission workload of ASBO. All admissions over a 2-year period for ASBO at two district general hospit als were identified through ICD1O diagnostic codes. Diagnostic investigatio ns, treatment patterns, ward stay and outcome information for admissions we re detailed from clinical records to develop mean cost estimates and assess the associated workload. Of the 298 admissions identified, 188 were not due to ASBO and were exclude d from analysis. Of the 110 admissions detailed, 41 (37%) were treated surg ically and 69 (63%) conservatively. Most admissions occurred through genera l practitioner referral (86.4%) to accident and emergency (90.0%). Mean (SD ) length of stay was 16.3 days (11.0 days) for surgical treatment and 7.0 d ays (4.6 days) for conservative treatment. In-patient mortality was 9.8% fo r the surgical group and 7.2% for the conservative group. Costs were based on the mean values from both centres for surgical and conservative admissio ns and detailed according to the cost of referral and follow-up (pound 100. 98 surgical versus pound 102.61 conservative), hospital ward and ICU stay ( pound3,327.48 versus pound1,267.92), theatre time (pound 832.32 surgical on ly), investigations (pound 282.73 versus pound 207.33) and drug costs (poun d 133.90 versus pound 28.29). Total treatment cost per admission for ASBO w as pound4,677.41 for surgically treated admissions and pound1,606.15 for co nservatively treated admissions. The impact of admissions for ASBO is considerable in terms of both costs an d workload. Bed stay for these admissions represents the equivalent of almo st one surgical bed per year and at least 2 days theatre time, impacting on surgical capacity and waiting lists. Adhesion prevention strategies may re duce the workload associated with ASBO. The review provides useful informat ion for planning resource allocation.