Comparisons of the surgical outcomes and medical costs between transferred and directly admitted patients diagnosed with intestinal obstruction in an American tertiary referral center
Purpose Intestinal obstruction is a leading cause of patient mortality and the most common reason for emergent operation in colorectal surgery. The influence of inter-hospital transfer on patients’ outcomes varies greatly in different diseases. We aimed to compare the surgical outcomes and medical c...
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| Veröffentlicht in: | International journal of colorectal disease 2018-11, Vol.33 (11), p.1617-1625 |
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| container_title | International journal of colorectal disease |
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| creator | Gao, Xian Hua Chouhan, Hanumant Gorgun, Emre Stocchi, Luca Ozuner, Gokhan |
| description | Purpose
Intestinal obstruction is a leading cause of patient mortality and the most common reason for emergent operation in colorectal surgery. The influence of inter-hospital transfer on patients’ outcomes varies greatly in different diseases. We aimed to compare the surgical outcomes and medical costs between transferred and directly admitted patients diagnosed with intestinal obstruction in an American tertiary referral center.
Methods
All intestinal obstruction patients operated in Cleveland Clinic from Jan 2012 to Dec 2016 were collected from a prospectively maintained database. Preoperative characteristics; surgical outcomes, including intraoperative complication, postoperative complication, readmission, reoperation, and postoperative 30-day mortality; and medical cost were collected. All parameters were compared between two groups before and after propensity score match. Multivariate logistic analysis was used to explore risk factors of surgical outcomes.
Results
A total of 576 patients were included, with 75 in the transferred group and 501 in the directly admitted group. Before match, the transferred patients had longer waiting interval from admission to surgery (
p
0.05), compared with the directly admitted group. Multivariate analysis showed that inter-hospital transfer was not an independent predictor of any surgical outcome. After matching to balance the preoperative characteristics between two groups, no significant differences were identified in all surgical outcomes and total medical cost between two groups (all
p
> 0.05).
Conclusions
Compared with directly admitted patients, transferred intestinal obstruction patients are associated with similar surgical outcomes and similar medical costs. |
| doi_str_mv | 10.1007/s00384-018-3052-4 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2028955585</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A714488348</galeid><sourcerecordid>A714488348</sourcerecordid><originalsourceid>FETCH-LOGICAL-c439t-f7d41e7a24fb17c1f17c1005d7473bafe84012953f6519ca35d590305709bba43</originalsourceid><addsrcrecordid>eNp1ksFu1DAQhiMEokvhAbggS1y4pNiOHcfH1QoKUiUucLYcZ7J1ldiL7ajqk_X1mOy2VCBQpET5880_48lfVW8ZvWCUqo-Z0qYTNWVd3VDJa_Gs2jDR8Jrxlj-vNpQpXTMtu7PqVc43FN9bJV5WZ1y3SjPJNtX9Ls4Hm3yOIZM4knINJC9p752dSFyKizNkYsNAZhiOoou5ZNJDuQUIpCQb8ggpwXCkBp_AlemO2GH2paB6sMVDwJLB232IGaVbX66JDwVy8WHt0-eSFld8DCijD9nOkLAb-kMq3qY7kmDtsvZHM0ivqxejnTK8eXieVz8-f_q--1Jffbv8utte1U40utSjGgQDZbkYe6YcG9cbpXJQQjW9HaETlHEtm7GVTDvbyEFqistUVPe9Fc159eHke0jx54IDm9lnB9NkA8QlG055p6WUnUT0_V_oTVwSnu9IKa1b0Ygnam8nMD6MEVfoVlOzVUyIrmtEh9TFPyi8Bpi9iwFGj_ofBexU4FLMGZdlDsnPuDjDqFnDYk5hMRgWs4bFrKO8exh46fHv_q54TAcC_ARk_BT2kJ5O9H_XX4kwzHI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2027996434</pqid></control><display><type>article</type><title>Comparisons of the surgical outcomes and medical costs between transferred and directly admitted patients diagnosed with intestinal obstruction in an American tertiary referral center</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Gao, Xian Hua ; Chouhan, Hanumant ; Gorgun, Emre ; Stocchi, Luca ; Ozuner, Gokhan</creator><creatorcontrib>Gao, Xian Hua ; Chouhan, Hanumant ; Gorgun, Emre ; Stocchi, Luca ; Ozuner, Gokhan</creatorcontrib><description>Purpose
Intestinal obstruction is a leading cause of patient mortality and the most common reason for emergent operation in colorectal surgery. The influence of inter-hospital transfer on patients’ outcomes varies greatly in different diseases. We aimed to compare the surgical outcomes and medical costs between transferred and directly admitted patients diagnosed with intestinal obstruction in an American tertiary referral center.
Methods
All intestinal obstruction patients operated in Cleveland Clinic from Jan 2012 to Dec 2016 were collected from a prospectively maintained database. Preoperative characteristics; surgical outcomes, including intraoperative complication, postoperative complication, readmission, reoperation, and postoperative 30-day mortality; and medical cost were collected. All parameters were compared between two groups before and after propensity score match. Multivariate logistic analysis was used to explore risk factors of surgical outcomes.
Results
A total of 576 patients were included, with 75 in the transferred group and 501 in the directly admitted group. Before match, the transferred patients had longer waiting interval from admission to surgery (
p
< 0.001), more contaminated or infected wounds (
p
= 0.02), different surgical procedures (
p
= 0.02), and similar surgical outcomes and total medical cost (all
p
> 0.05), compared with the directly admitted group. Multivariate analysis showed that inter-hospital transfer was not an independent predictor of any surgical outcome. After matching to balance the preoperative characteristics between two groups, no significant differences were identified in all surgical outcomes and total medical cost between two groups (all
p
> 0.05).
Conclusions
Compared with directly admitted patients, transferred intestinal obstruction patients are associated with similar surgical outcomes and similar medical costs.</description><identifier>ISSN: 0179-1958</identifier><identifier>EISSN: 1432-1262</identifier><identifier>DOI: 10.1007/s00384-018-3052-4</identifier><identifier>PMID: 29679151</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Analysis ; Costs ; Economic aspects ; Female ; Gastroenterology ; Hepatology ; Hospital Costs ; Hospitalization - economics ; Humans ; Internal Medicine ; Intestinal obstruction ; Intestinal Obstruction - diagnosis ; Intestinal Obstruction - economics ; Intestinal Obstruction - surgery ; Intestine ; Intestines ; Logistic Models ; Male ; Medical care, Cost of ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; Multivariate Analysis ; Obstructions ; Original Article ; Patient Transfer - economics ; Proctology ; Referral and Consultation - economics ; Risk Factors ; Surgery ; Surgical outcomes ; Tertiary Care Centers - economics ; Treatment Outcome ; United States</subject><ispartof>International journal of colorectal disease, 2018-11, Vol.33 (11), p.1617-1625</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><rights>COPYRIGHT 2018 Springer</rights><rights>International Journal of Colorectal Disease is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-f7d41e7a24fb17c1f17c1005d7473bafe84012953f6519ca35d590305709bba43</citedby><cites>FETCH-LOGICAL-c439t-f7d41e7a24fb17c1f17c1005d7473bafe84012953f6519ca35d590305709bba43</cites><orcidid>0000-0001-8020-6946</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00384-018-3052-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00384-018-3052-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29679151$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gao, Xian Hua</creatorcontrib><creatorcontrib>Chouhan, Hanumant</creatorcontrib><creatorcontrib>Gorgun, Emre</creatorcontrib><creatorcontrib>Stocchi, Luca</creatorcontrib><creatorcontrib>Ozuner, Gokhan</creatorcontrib><title>Comparisons of the surgical outcomes and medical costs between transferred and directly admitted patients diagnosed with intestinal obstruction in an American tertiary referral center</title><title>International journal of colorectal disease</title><addtitle>Int J Colorectal Dis</addtitle><addtitle>Int J Colorectal Dis</addtitle><description>Purpose
Intestinal obstruction is a leading cause of patient mortality and the most common reason for emergent operation in colorectal surgery. The influence of inter-hospital transfer on patients’ outcomes varies greatly in different diseases. We aimed to compare the surgical outcomes and medical costs between transferred and directly admitted patients diagnosed with intestinal obstruction in an American tertiary referral center.
Methods
All intestinal obstruction patients operated in Cleveland Clinic from Jan 2012 to Dec 2016 were collected from a prospectively maintained database. Preoperative characteristics; surgical outcomes, including intraoperative complication, postoperative complication, readmission, reoperation, and postoperative 30-day mortality; and medical cost were collected. All parameters were compared between two groups before and after propensity score match. Multivariate logistic analysis was used to explore risk factors of surgical outcomes.
Results
A total of 576 patients were included, with 75 in the transferred group and 501 in the directly admitted group. Before match, the transferred patients had longer waiting interval from admission to surgery (
p
< 0.001), more contaminated or infected wounds (
p
= 0.02), different surgical procedures (
p
= 0.02), and similar surgical outcomes and total medical cost (all
p
> 0.05), compared with the directly admitted group. Multivariate analysis showed that inter-hospital transfer was not an independent predictor of any surgical outcome. After matching to balance the preoperative characteristics between two groups, no significant differences were identified in all surgical outcomes and total medical cost between two groups (all
p
> 0.05).
Conclusions
Compared with directly admitted patients, transferred intestinal obstruction patients are associated with similar surgical outcomes and similar medical costs.</description><subject>Analysis</subject><subject>Costs</subject><subject>Economic aspects</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Hospital Costs</subject><subject>Hospitalization - economics</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Intestinal obstruction</subject><subject>Intestinal Obstruction - diagnosis</subject><subject>Intestinal Obstruction - economics</subject><subject>Intestinal Obstruction - surgery</subject><subject>Intestine</subject><subject>Intestines</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical care, Cost of</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Obstructions</subject><subject>Original Article</subject><subject>Patient Transfer - economics</subject><subject>Proctology</subject><subject>Referral and Consultation - economics</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Tertiary Care Centers - economics</subject><subject>Treatment Outcome</subject><subject>United States</subject><issn>0179-1958</issn><issn>1432-1262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1ksFu1DAQhiMEokvhAbggS1y4pNiOHcfH1QoKUiUucLYcZ7J1ldiL7ajqk_X1mOy2VCBQpET5880_48lfVW8ZvWCUqo-Z0qYTNWVd3VDJa_Gs2jDR8Jrxlj-vNpQpXTMtu7PqVc43FN9bJV5WZ1y3SjPJNtX9Ls4Hm3yOIZM4knINJC9p752dSFyKizNkYsNAZhiOoou5ZNJDuQUIpCQb8ggpwXCkBp_AlemO2GH2paB6sMVDwJLB232IGaVbX66JDwVy8WHt0-eSFld8DCijD9nOkLAb-kMq3qY7kmDtsvZHM0ivqxejnTK8eXieVz8-f_q--1Jffbv8utte1U40utSjGgQDZbkYe6YcG9cbpXJQQjW9HaETlHEtm7GVTDvbyEFqistUVPe9Fc159eHke0jx54IDm9lnB9NkA8QlG055p6WUnUT0_V_oTVwSnu9IKa1b0Ygnam8nMD6MEVfoVlOzVUyIrmtEh9TFPyi8Bpi9iwFGj_ofBexU4FLMGZdlDsnPuDjDqFnDYk5hMRgWs4bFrKO8exh46fHv_q54TAcC_ARk_BT2kJ5O9H_XX4kwzHI</recordid><startdate>20181101</startdate><enddate>20181101</enddate><creator>Gao, Xian Hua</creator><creator>Chouhan, Hanumant</creator><creator>Gorgun, Emre</creator><creator>Stocchi, Luca</creator><creator>Ozuner, Gokhan</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8020-6946</orcidid></search><sort><creationdate>20181101</creationdate><title>Comparisons of the surgical outcomes and medical costs between transferred and directly admitted patients diagnosed with intestinal obstruction in an American tertiary referral center</title><author>Gao, Xian Hua ; Chouhan, Hanumant ; Gorgun, Emre ; Stocchi, Luca ; Ozuner, Gokhan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-f7d41e7a24fb17c1f17c1005d7473bafe84012953f6519ca35d590305709bba43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Analysis</topic><topic>Costs</topic><topic>Economic aspects</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Hospital Costs</topic><topic>Hospitalization - economics</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Intestinal obstruction</topic><topic>Intestinal Obstruction - diagnosis</topic><topic>Intestinal Obstruction - economics</topic><topic>Intestinal Obstruction - surgery</topic><topic>Intestine</topic><topic>Intestines</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical care, Cost of</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Obstructions</topic><topic>Original Article</topic><topic>Patient Transfer - economics</topic><topic>Proctology</topic><topic>Referral and Consultation - economics</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Tertiary Care Centers - economics</topic><topic>Treatment Outcome</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gao, Xian Hua</creatorcontrib><creatorcontrib>Chouhan, Hanumant</creatorcontrib><creatorcontrib>Gorgun, Emre</creatorcontrib><creatorcontrib>Stocchi, Luca</creatorcontrib><creatorcontrib>Ozuner, Gokhan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gao, Xian Hua</au><au>Chouhan, Hanumant</au><au>Gorgun, Emre</au><au>Stocchi, Luca</au><au>Ozuner, Gokhan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparisons of the surgical outcomes and medical costs between transferred and directly admitted patients diagnosed with intestinal obstruction in an American tertiary referral center</atitle><jtitle>International journal of colorectal disease</jtitle><stitle>Int J Colorectal Dis</stitle><addtitle>Int J Colorectal Dis</addtitle><date>2018-11-01</date><risdate>2018</risdate><volume>33</volume><issue>11</issue><spage>1617</spage><epage>1625</epage><pages>1617-1625</pages><issn>0179-1958</issn><eissn>1432-1262</eissn><abstract>Purpose
Intestinal obstruction is a leading cause of patient mortality and the most common reason for emergent operation in colorectal surgery. The influence of inter-hospital transfer on patients’ outcomes varies greatly in different diseases. We aimed to compare the surgical outcomes and medical costs between transferred and directly admitted patients diagnosed with intestinal obstruction in an American tertiary referral center.
Methods
All intestinal obstruction patients operated in Cleveland Clinic from Jan 2012 to Dec 2016 were collected from a prospectively maintained database. Preoperative characteristics; surgical outcomes, including intraoperative complication, postoperative complication, readmission, reoperation, and postoperative 30-day mortality; and medical cost were collected. All parameters were compared between two groups before and after propensity score match. Multivariate logistic analysis was used to explore risk factors of surgical outcomes.
Results
A total of 576 patients were included, with 75 in the transferred group and 501 in the directly admitted group. Before match, the transferred patients had longer waiting interval from admission to surgery (
p
< 0.001), more contaminated or infected wounds (
p
= 0.02), different surgical procedures (
p
= 0.02), and similar surgical outcomes and total medical cost (all
p
> 0.05), compared with the directly admitted group. Multivariate analysis showed that inter-hospital transfer was not an independent predictor of any surgical outcome. After matching to balance the preoperative characteristics between two groups, no significant differences were identified in all surgical outcomes and total medical cost between two groups (all
p
> 0.05).
Conclusions
Compared with directly admitted patients, transferred intestinal obstruction patients are associated with similar surgical outcomes and similar medical costs.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>29679151</pmid><doi>10.1007/s00384-018-3052-4</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-8020-6946</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0179-1958 |
| ispartof | International journal of colorectal disease, 2018-11, Vol.33 (11), p.1617-1625 |
| issn | 0179-1958 1432-1262 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2028955585 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Analysis Costs Economic aspects Female Gastroenterology Hepatology Hospital Costs Hospitalization - economics Humans Internal Medicine Intestinal obstruction Intestinal Obstruction - diagnosis Intestinal Obstruction - economics Intestinal Obstruction - surgery Intestine Intestines Logistic Models Male Medical care, Cost of Medicine Medicine & Public Health Middle Aged Mortality Multivariate Analysis Obstructions Original Article Patient Transfer - economics Proctology Referral and Consultation - economics Risk Factors Surgery Surgical outcomes Tertiary Care Centers - economics Treatment Outcome United States |
| title | Comparisons of the surgical outcomes and medical costs between transferred and directly admitted patients diagnosed with intestinal obstruction in an American tertiary referral center |
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