Cargando…

Impact of postcolectomy adhesion-related complications on healthcare utilization

OBJECTIVE: The objective of this study was to explore adhesion-related complications (ARCs) within 1 year after colectomy. METHODS: Using Truven MarketScan® Commercial and Medicare databases, the first inpatient colectomies during 2009–2013 (index) were identified: left, right, partial, transverse,...

Descripción completa

Detalles Bibliográficos
Autores principales: Etter, Katherine, Sutton, Nadia, Wei, David, Yoo, Andrew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241541/
https://www.ncbi.nlm.nih.gov/pubmed/30532568
http://dx.doi.org/10.2147/CEOR.S167741
_version_ 1783371776696254464
author Etter, Katherine
Sutton, Nadia
Wei, David
Yoo, Andrew
author_facet Etter, Katherine
Sutton, Nadia
Wei, David
Yoo, Andrew
author_sort Etter, Katherine
collection PubMed
description OBJECTIVE: The objective of this study was to explore adhesion-related complications (ARCs) within 1 year after colectomy. METHODS: Using Truven MarketScan® Commercial and Medicare databases, the first inpatient colectomies during 2009–2013 (index) were identified: left, right, partial, transverse, or total. One-year continuous enrollment was required pre and postindex. Only the first inpatient rehospitalization event was analyzed. ARC was defined as the subset of rehospitalizations with a diagnosis of ileus, small bowel obstruction, or postindex adhesiolysis. ARC and non-ARC events were evaluated descriptively, including time to ARC, length of stay (LOS), and total hospitalization reimbursement (2015 US dollars [2015 USD]). Patient, provider, and procedure factors associated with ARC were explored using logistic regression models. RESULTS: A total of 64,532 colectomies were identified: left (39.2%), right (34.9%), partial (20.0%), transverse (2.3%), and total (3.6%). Surgical approach was classified as open (60.1%) and laparoscopic (39.9%). All-cause first inpatient readmission incidence within 1 year was 24.7%, and ARC incidence was 5.7% in all patients or 23.2% in all first readmissions. ARC had statistically higher resource utilization compared to non-ARC with respective mean (SD) time to event (130 [102] and 137 [106] days), mean (SD) LOS (7.2 [8.0] and 5.2 [6.8] days), and mean (SD) total reimbursement ($29,802 [$43,037] and $22,476 [$36,130]). ARC risk factors included (OR [95% CI]) resection type (total vs right, 3.78 [3.27–4.36]), left vs right (1.69 [1.53–1.86]), adhesiolysis (2.45 [1.42–4.23]), computerized tomography (1.79 [1.65–1.95]), surgical indication: inflammatory bowel disease vs cancer (1.69 [1.43–1.99]), and multiple abdominal procedures (1.38 [1.29–1.49]). Laparoscopic approach was protective (0.42 [0.39–0.46]). CONCLUSION: ARCs were associated with almost one-fourth of all first rehospitalizations within the first year after colectomy and were associated with substantial healthcare utilization. Risk factors included increased index colectomy complexity, while the laparoscopic approach was protective. Future research is needed to better identify high-risk patients and allow for appropriate economic and clinical risk adjustment of outcomes.
format Online
Article
Text
id pubmed-6241541
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Dove Medical Press
record_format MEDLINE/PubMed
spelling pubmed-62415412018-12-07 Impact of postcolectomy adhesion-related complications on healthcare utilization Etter, Katherine Sutton, Nadia Wei, David Yoo, Andrew Clinicoecon Outcomes Res Original Research OBJECTIVE: The objective of this study was to explore adhesion-related complications (ARCs) within 1 year after colectomy. METHODS: Using Truven MarketScan® Commercial and Medicare databases, the first inpatient colectomies during 2009–2013 (index) were identified: left, right, partial, transverse, or total. One-year continuous enrollment was required pre and postindex. Only the first inpatient rehospitalization event was analyzed. ARC was defined as the subset of rehospitalizations with a diagnosis of ileus, small bowel obstruction, or postindex adhesiolysis. ARC and non-ARC events were evaluated descriptively, including time to ARC, length of stay (LOS), and total hospitalization reimbursement (2015 US dollars [2015 USD]). Patient, provider, and procedure factors associated with ARC were explored using logistic regression models. RESULTS: A total of 64,532 colectomies were identified: left (39.2%), right (34.9%), partial (20.0%), transverse (2.3%), and total (3.6%). Surgical approach was classified as open (60.1%) and laparoscopic (39.9%). All-cause first inpatient readmission incidence within 1 year was 24.7%, and ARC incidence was 5.7% in all patients or 23.2% in all first readmissions. ARC had statistically higher resource utilization compared to non-ARC with respective mean (SD) time to event (130 [102] and 137 [106] days), mean (SD) LOS (7.2 [8.0] and 5.2 [6.8] days), and mean (SD) total reimbursement ($29,802 [$43,037] and $22,476 [$36,130]). ARC risk factors included (OR [95% CI]) resection type (total vs right, 3.78 [3.27–4.36]), left vs right (1.69 [1.53–1.86]), adhesiolysis (2.45 [1.42–4.23]), computerized tomography (1.79 [1.65–1.95]), surgical indication: inflammatory bowel disease vs cancer (1.69 [1.43–1.99]), and multiple abdominal procedures (1.38 [1.29–1.49]). Laparoscopic approach was protective (0.42 [0.39–0.46]). CONCLUSION: ARCs were associated with almost one-fourth of all first rehospitalizations within the first year after colectomy and were associated with substantial healthcare utilization. Risk factors included increased index colectomy complexity, while the laparoscopic approach was protective. Future research is needed to better identify high-risk patients and allow for appropriate economic and clinical risk adjustment of outcomes. Dove Medical Press 2018-11-14 /pmc/articles/PMC6241541/ /pubmed/30532568 http://dx.doi.org/10.2147/CEOR.S167741 Text en © 2018 Etter et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Etter, Katherine
Sutton, Nadia
Wei, David
Yoo, Andrew
Impact of postcolectomy adhesion-related complications on healthcare utilization
title Impact of postcolectomy adhesion-related complications on healthcare utilization
title_full Impact of postcolectomy adhesion-related complications on healthcare utilization
title_fullStr Impact of postcolectomy adhesion-related complications on healthcare utilization
title_full_unstemmed Impact of postcolectomy adhesion-related complications on healthcare utilization
title_short Impact of postcolectomy adhesion-related complications on healthcare utilization
title_sort impact of postcolectomy adhesion-related complications on healthcare utilization
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241541/
https://www.ncbi.nlm.nih.gov/pubmed/30532568
http://dx.doi.org/10.2147/CEOR.S167741
work_keys_str_mv AT etterkatherine impactofpostcolectomyadhesionrelatedcomplicationsonhealthcareutilization
AT suttonnadia impactofpostcolectomyadhesionrelatedcomplicationsonhealthcareutilization
AT weidavid impactofpostcolectomyadhesionrelatedcomplicationsonhealthcareutilization
AT yooandrew impactofpostcolectomyadhesionrelatedcomplicationsonhealthcareutilization