Menzies D, Parker M, Hoare R, Knight A
Department of Surgery, Colchester General Hospital, Colchester, Essex, UK.
Ann R Coll Surg Engl. 2001 Jan;83(1):40-6.
The workload and costs of the emergency admissions and treatment of adhesive 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 hospitals were identified through ICD10 diagnostic codes. Diagnostic investigations, treatment patterns, ward stay and outcome information for admissions were 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 excluded from analysis. Of the 110 admissions detailed, 41 (37%) were treated surgically and 69 (63%) conservatively. Most admissions occurred through general 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 days (4.6 days) for conservative treatment. In-patient mortality was 9.8% for the surgical group and 7.2% for the conservative group. Costs were based on the mean values from both centres for surgical and conservative admissions and detailed according to the cost of referral and follow-up (100.98 Pounds surgical versus 102.61 Pounds conservative), hospital ward and ICU stay (3,327.48 Pounds versus 1,267.92 Pounds), theatre time (832.32 Pounds surgical only), investigations (282.73 Pounds versus 207.33 Pounds) and drug costs (133.90 Pounds versus 28.29 Pounds). Total treatment cost per admission for ASBO was 4,677.41 Pounds for surgically treated admissions and 1,606.15 Pounds for conservatively treated admissions. The impact of admissions for ASBO is considerable in terms of both costs and workload. Bed stay for these admissions represents the equivalent of almost one surgical bed per year and at least 2 days theatre time, impacting on surgical capacity and waiting lists. Adhesion prevention strategies may reduce the workload associated with ASBO. The review provides useful information for planning resource allocation.
粘连性小肠梗阻（ASBO）急诊入院及治疗的工作量和成本尚不清楚。本综述详细阐述了ASBO的入院工作量并计算了成本。通过ICD10诊断编码确定了两家区级综合医院两年内所有ASBO的入院病例。从临床记录中详细获取入院病例的诊断检查、治疗方式、病房停留时间及预后信息，以制定平均成本估算并评估相关工作量。在确定的298例入院病例中，188例并非由ASBO导致，被排除在分析之外。在详细分析的110例入院病例中，41例（37%）接受了手术治疗，69例（63%）接受了保守治疗。大多数入院病例是通过全科医生转诊（86.4%）至急诊（90.0%）。手术治疗的平均（标准差）住院时间为16.3天（11.0天），保守治疗为7.0天（4.6天）。手术组的住院死亡率为9.8%，保守组为7.2%。成本基于两个中心手术和保守入院病例的平均值，并根据转诊和随访成本（手术组100.98英镑，保守组102.61英镑）、医院病房和重症监护病房停留成本（3327.48英镑对1267.92英镑）、手术时间成本（仅手术组832.32英镑）、检查成本（282.73英镑对207.33英镑）和药物成本（133.90英镑对28.29英镑）进行详细计算。ASBO手术治疗入院病例的每次治疗总成本为4677.41英镑，保守治疗入院病例为1606.15英镑。ASBO入院病例在成本和工作量方面的影响相当大。这些入院病例的床位占用相当于每年近一张手术床位以及至少2天的手术时间，对手术能力和等待名单产生影响。粘连预防策略可能会减少与ASBO相关联的工作量。本综述为规划资源分配提供了有用信息。
