Cost effectiveness analysis of duration of nonoperative management for adhesive bowel obstruction in a developing country|
Samuel, Olatoke; Olayide, Agodirin; Ganiyu, Rahman; Funsho, Yusuf & Olusola, Adesiyun
Adhesive bowel obstruction (ABO) costs billions of dollars in developed countries. Cost is unknown in developing
countries. This depends on the type of management and duration of hospital stay. Nonoperative management (NOM)
of uncomplicated obstruction is safe for up to 10 days. While it remains cost effective, the most efficient duration of
nonoperative management must retain its advantages over operative management.
To describe cost effectiveness of various durations of nonoperative management of adhesive obstruction in a developing
Over 2 year period, Patients who had uncomplicated adhesive obstruction were observed on trial of nonoperative
management. Length of hospital stay and success rate were combined as surrogates for Cost effectiveness analysis of 2 to
5 days and ≥7 days nonoperative management.
41 patients (24(58.5%) females) were eligible. Mean age 38.4 ± 14.7 (range 18-80) years. 31 (75.6%) were first time admissions.
The most common previous abdominal operations were for appendix and obstetrics and gynecologic pathologies. Median
duration of nonoperative management (dNOM) was 4 days, median LOS was 9 days. Nonoperative management was
successful in 53.7% (22 patients). Total estimated direct hospital cost of 41 adhesive bowel obstructions was $133,279.
Total personnel charges were $112,142. Mean operative and nonoperative management was $4,914 and $1,814 respectively
(p <0.0001). Most of successful nonoperative management was within 5 days. 4 days nonoperative management had the
highest cost utility.
From this study, without indications for immediate surgical intervention, 4 days nonoperative management is the most cost
effective course, after which surgical intervention may be considered if there is no improvement.