Geographic Variation in Operative Management of Adhesive Small Bowel Obstruction.
J Surg Res
; 286: 57-64, 2023 06.
Article
em En
| MEDLINE
| ID: mdl-36753950
ABSTRACT
INTRODUCTION:
Variation in surgical management exists nationally. We hypothesize that geographic variation exists in adhesive small bowel obstruction (aSBO) management. MATERIALS ANDMETHODS:
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.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Obstrução Intestinal
Tipo de estudo:
Observational_studies
/
Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Humans
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Male
Idioma:
En
Revista:
J Surg Res
Ano de publicação:
2023
Tipo de documento:
Article