M. E. Sternick1, A. Van Horn1, E. Sturm1, A. P. Soult1, R. C. Britt1 1Eastern Virginia Medical School, General Surgery, Norfolk, VA, USA
Introduction:
Small bowel obstructions (SBO) substantially impact the healthcare system and patient quality of life. In a previous study, we showed that patients with SBO admitted to a surgical rather than medical service had a decreased length of stay (LOS) and total cost. The reason for the disparity in outcomes is unclear. The present study aimed to better evaluate factors contributing to the decision of admitting service and outcomes.
Methods:
A retrospective chart review was performed for 799 patients admitted to a Sentara Facility between 2012 and 2019 with a diagnosis of SBO. Patients between the ages of 18 and 89 were included. Patients were excluded if they required emergent operation. Patients were evaluated based on the admitting service’s specialty. The groups were compared with regards to age, BMI, LOS, cost, hospital type (academic or community), prior number of abdominal operations, and 30-day readmission.
Results:
Of the 799 patients admitted with a SBO, 180 (22.5%) were admitted to a medical service, and 619 (77.5%) were admitted to a surgical service. At the community hospitals 78% of patients were admitted to the medical service, while at the academic medical centers only 31% of patients were admitted to the medical service (p<0.0001). The average LOS (7.10 ± 6.65 vs. 9.53 ± 7.26, p<0.0001) and cost ($32,233.56 ± $35,078 vs $49,425.72 ± $54,902, p<0.0001) were significantly lower for surgical admission. Both groups had similar rates of surgery during the hospitalization, in 26% of medical admissions and 22.7% surgical admissions. The 30-day readmission rate was higher for surgical service (22% vs 13.3%, <0.01). Patients admitted to medicine had a greater number of comorbid conditions (3.23 ± 2.02 vs 2.39 ± 1.88, p<0.0001) and were generally older (65.38 ± 16.46 vs 62.41 ± 15.46, p<0.02). No difference was seen in the number of prior operations or BMI.
Conclusion:
Overall, patients with SBO admitted to surgical services had a decreased LOS and total hospital cost. While patients admitted to medicine had more comorbidities and were slightly older, it is unclear if this explains the significant increases in cost and LOS. Patients at a community hospital were significantly more likely to be admitted to the medical service. In contrast, the majority of patients at academic centers were admitted to surgery. Despite the continued support for surgical services admitting SBO patients with respect to LOS and cost, the 30-day readmission rate was higher for surgical services. Further work should be conducted to clarify the higher readmission rates for the surgical service.
