Adhesions are Common and Costly after Open Pouch Surgery
Purpose Open ileal pouch surgery leads to high rates of adhesive small-bowel obstruction (SBO). A laparoscopic approach may reduce these complications. We aimed to review the incidence of adhesive SBO-related complications after open pouch surgery and to model the potential financial impact of a lap...
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| Veröffentlicht in: | Journal of gastrointestinal surgery 2008-07, Vol.12 (7), p.1239-1245 |
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| creator | Sileri, Pierpaolo Sthory, Roberto McVeigh, Enda Child, Tim Cunningham, Chris Mortensen, Neil J. Lindsey, Ian |
| description | Purpose
Open ileal pouch surgery leads to high rates of adhesive small-bowel obstruction (SBO). A laparoscopic approach may reduce these complications. We aimed to review the incidence of adhesive SBO-related complications after open pouch surgery and to model the potential financial impact of a laparoscopic approach purely as an adhesion prevention strategy.
Materials and Methods
We reviewed cases of open ileal pouch patients kept on a database and examined annually. Case notes were studied for episodes of adhesive SBO requiring admission or reoperation. Similar parameters were studied in a small series undergoing laparoscopic pouch surgery. The financial burden of the open access complications was estimated and potential financial impact of a laparoscopic approach modeled.
Results
Two hundred seventy-six patients were followed up after open surgery (median, 6.3; range, 0.2–20.1 years). There were 76 (28%) readmissions (median length of stay, 7.4 days) in 53 patients (19%) and 28 (10%) reoperations (43% within 1 year). Laparoscopic patients required less adhesiolysis at second-stage surgery (0% vs 36%,
p
|
| doi_str_mv | 10.1007/s11605-008-0481-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69260818</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2790392381</sourcerecordid><originalsourceid>FETCH-LOGICAL-c370t-9940e58e3262489fefa74aff8badd8c88e5376de06d27e0cc76f99ca45ae56203</originalsourceid><addsrcrecordid>eNp1kN9LwzAQx4Mobk7_AF-kIPhWvSRtkj6O4S8YTFDBt5C1F7fRNjNpH_bfm9GBIvh0B_e57x0fQi4p3FIAeRcoFZCnACqFTNGUH5ExVZKnmWDiOPZQ0JTl-ceInIWwAaASqDolI6qYVDkvxkRNqxWGtWtDYjwmM9c0rk1MW8U2dPUuMbZDnyy22CYvri9XyWvvP9HvzsmJNXXAi0OdkPeH-7fZUzpfPD7PpvO05BK6tCgywFwhZ4JlqrBojcyMtWppqkqVSmHOpagQRMUkQllKYYuiNFluMBcM-ITcDLlb7756DJ1u1qHEujYtuj5oUTABiqoIXv8BN673bfxNU0oZFyLejxQdqNK7EDxavfXrxvidpqD3UvUgVUepei9V87hzdUjulw1WPxsHixFgAxDiqI12fp3-N_Ubm3mARg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1112366489</pqid></control><display><type>article</type><title>Adhesions are Common and Costly after Open Pouch Surgery</title><source>MEDLINE</source><source>SpringerNature Complete Journals</source><creator>Sileri, Pierpaolo ; Sthory, Roberto ; McVeigh, Enda ; Child, Tim ; Cunningham, Chris ; Mortensen, Neil J. ; Lindsey, Ian</creator><creatorcontrib>Sileri, Pierpaolo ; Sthory, Roberto ; McVeigh, Enda ; Child, Tim ; Cunningham, Chris ; Mortensen, Neil J. ; Lindsey, Ian</creatorcontrib><description>Purpose
Open ileal pouch surgery leads to high rates of adhesive small-bowel obstruction (SBO). A laparoscopic approach may reduce these complications. We aimed to review the incidence of adhesive SBO-related complications after open pouch surgery and to model the potential financial impact of a laparoscopic approach purely as an adhesion prevention strategy.
Materials and Methods
We reviewed cases of open ileal pouch patients kept on a database and examined annually. Case notes were studied for episodes of adhesive SBO requiring admission or reoperation. Similar parameters were studied in a small series undergoing laparoscopic pouch surgery. The financial burden of the open access complications was estimated and potential financial impact of a laparoscopic approach modeled.
Results
Two hundred seventy-six patients were followed up after open surgery (median, 6.3; range, 0.2–20.1 years). There were 76 (28%) readmissions (median length of stay, 7.4 days) in 53 patients (19%) and 28 (10%) reoperations (43% within 1 year). Laparoscopic patients required less adhesiolysis at second-stage surgery (0% vs 36%,
p
< 0.0001) and had less SBO episodes within 12 months of surgery (0% vs 14%,
p
< 0.0001) than open patients. Modeling a laparoscopic approach cost $1,450 and saved $3,282, thus netting $1,832 per pouch constructed.
Conclusion
Open ileal pouch surgery results in significant cumulative long-term access-related complications, particularly adhesions. These impose a large medical burden on patients and financial burden on health-care systems, all of which may be recouped by a laparoscopic approach, despite higher theater costs.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-008-0481-3</identifier><identifier>PMID: 18278539</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Adult ; Colonic Diseases - surgery ; Colonic Pouches - pathology ; Cost-Benefit Analysis ; Female ; Follow-Up Studies ; Gastroenterology ; Humans ; Ileal Diseases - epidemiology ; Ileal Diseases - etiology ; Ileal Diseases - prevention & control ; Incidence ; Intestinal Obstruction - epidemiology ; Intestinal Obstruction - etiology ; Intestinal Obstruction - prevention & control ; Laparoscopy - economics ; Laparoscopy - methods ; Male ; Medicine ; Medicine & Public Health ; Original Article ; Postoperative Complications ; Prognosis ; Prospective Studies ; Surgery ; Tissue Adhesions - economics ; Tissue Adhesions - epidemiology ; Tissue Adhesions - prevention & control ; United Kingdom - epidemiology</subject><ispartof>Journal of gastrointestinal surgery, 2008-07, Vol.12 (7), p.1239-1245</ispartof><rights>The Society for Surgery of the Alimentary Tract 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c370t-9940e58e3262489fefa74aff8badd8c88e5376de06d27e0cc76f99ca45ae56203</citedby><cites>FETCH-LOGICAL-c370t-9940e58e3262489fefa74aff8badd8c88e5376de06d27e0cc76f99ca45ae56203</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-008-0481-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-008-0481-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18278539$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sileri, Pierpaolo</creatorcontrib><creatorcontrib>Sthory, Roberto</creatorcontrib><creatorcontrib>McVeigh, Enda</creatorcontrib><creatorcontrib>Child, Tim</creatorcontrib><creatorcontrib>Cunningham, Chris</creatorcontrib><creatorcontrib>Mortensen, Neil J.</creatorcontrib><creatorcontrib>Lindsey, Ian</creatorcontrib><title>Adhesions are Common and Costly after Open Pouch Surgery</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>Purpose
Open ileal pouch surgery leads to high rates of adhesive small-bowel obstruction (SBO). A laparoscopic approach may reduce these complications. We aimed to review the incidence of adhesive SBO-related complications after open pouch surgery and to model the potential financial impact of a laparoscopic approach purely as an adhesion prevention strategy.
Materials and Methods
We reviewed cases of open ileal pouch patients kept on a database and examined annually. Case notes were studied for episodes of adhesive SBO requiring admission or reoperation. Similar parameters were studied in a small series undergoing laparoscopic pouch surgery. The financial burden of the open access complications was estimated and potential financial impact of a laparoscopic approach modeled.
Results
Two hundred seventy-six patients were followed up after open surgery (median, 6.3; range, 0.2–20.1 years). There were 76 (28%) readmissions (median length of stay, 7.4 days) in 53 patients (19%) and 28 (10%) reoperations (43% within 1 year). Laparoscopic patients required less adhesiolysis at second-stage surgery (0% vs 36%,
p
< 0.0001) and had less SBO episodes within 12 months of surgery (0% vs 14%,
p
< 0.0001) than open patients. Modeling a laparoscopic approach cost $1,450 and saved $3,282, thus netting $1,832 per pouch constructed.
Conclusion
Open ileal pouch surgery results in significant cumulative long-term access-related complications, particularly adhesions. These impose a large medical burden on patients and financial burden on health-care systems, all of which may be recouped by a laparoscopic approach, despite higher theater costs.</description><subject>Adult</subject><subject>Colonic Diseases - surgery</subject><subject>Colonic Pouches - pathology</subject><subject>Cost-Benefit Analysis</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology</subject><subject>Humans</subject><subject>Ileal Diseases - epidemiology</subject><subject>Ileal Diseases - etiology</subject><subject>Ileal Diseases - prevention & control</subject><subject>Incidence</subject><subject>Intestinal Obstruction - epidemiology</subject><subject>Intestinal Obstruction - etiology</subject><subject>Intestinal Obstruction - prevention & control</subject><subject>Laparoscopy - economics</subject><subject>Laparoscopy - methods</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Postoperative Complications</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Surgery</subject><subject>Tissue Adhesions - economics</subject><subject>Tissue Adhesions - epidemiology</subject><subject>Tissue Adhesions - prevention & control</subject><subject>United Kingdom - epidemiology</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kN9LwzAQx4Mobk7_AF-kIPhWvSRtkj6O4S8YTFDBt5C1F7fRNjNpH_bfm9GBIvh0B_e57x0fQi4p3FIAeRcoFZCnACqFTNGUH5ExVZKnmWDiOPZQ0JTl-ceInIWwAaASqDolI6qYVDkvxkRNqxWGtWtDYjwmM9c0rk1MW8U2dPUuMbZDnyy22CYvri9XyWvvP9HvzsmJNXXAi0OdkPeH-7fZUzpfPD7PpvO05BK6tCgywFwhZ4JlqrBojcyMtWppqkqVSmHOpagQRMUkQllKYYuiNFluMBcM-ITcDLlb7756DJ1u1qHEujYtuj5oUTABiqoIXv8BN673bfxNU0oZFyLejxQdqNK7EDxavfXrxvidpqD3UvUgVUepei9V87hzdUjulw1WPxsHixFgAxDiqI12fp3-N_Ubm3mARg</recordid><startdate>20080701</startdate><enddate>20080701</enddate><creator>Sileri, Pierpaolo</creator><creator>Sthory, Roberto</creator><creator>McVeigh, Enda</creator><creator>Child, Tim</creator><creator>Cunningham, Chris</creator><creator>Mortensen, Neil J.</creator><creator>Lindsey, Ian</creator><general>Springer-Verlag</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>7RV</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>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20080701</creationdate><title>Adhesions are Common and Costly after Open Pouch Surgery</title><author>Sileri, Pierpaolo ; Sthory, Roberto ; McVeigh, Enda ; Child, Tim ; Cunningham, Chris ; Mortensen, Neil J. ; Lindsey, Ian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c370t-9940e58e3262489fefa74aff8badd8c88e5376de06d27e0cc76f99ca45ae56203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Colonic Diseases - surgery</topic><topic>Colonic Pouches - pathology</topic><topic>Cost-Benefit Analysis</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology</topic><topic>Humans</topic><topic>Ileal Diseases - epidemiology</topic><topic>Ileal Diseases - etiology</topic><topic>Ileal Diseases - prevention & control</topic><topic>Incidence</topic><topic>Intestinal Obstruction - epidemiology</topic><topic>Intestinal Obstruction - etiology</topic><topic>Intestinal Obstruction - prevention & control</topic><topic>Laparoscopy - economics</topic><topic>Laparoscopy - methods</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Postoperative Complications</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Surgery</topic><topic>Tissue Adhesions - economics</topic><topic>Tissue Adhesions - epidemiology</topic><topic>Tissue Adhesions - prevention & control</topic><topic>United Kingdom - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sileri, Pierpaolo</creatorcontrib><creatorcontrib>Sthory, Roberto</creatorcontrib><creatorcontrib>McVeigh, Enda</creatorcontrib><creatorcontrib>Child, Tim</creatorcontrib><creatorcontrib>Cunningham, Chris</creatorcontrib><creatorcontrib>Mortensen, Neil J.</creatorcontrib><creatorcontrib>Lindsey, Ian</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>Nursing & Allied Health Database</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)</collection><collection>ProQuest Central</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>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sileri, Pierpaolo</au><au>Sthory, Roberto</au><au>McVeigh, Enda</au><au>Child, Tim</au><au>Cunningham, Chris</au><au>Mortensen, Neil J.</au><au>Lindsey, Ian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adhesions are Common and Costly after Open Pouch Surgery</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2008-07-01</date><risdate>2008</risdate><volume>12</volume><issue>7</issue><spage>1239</spage><epage>1245</epage><pages>1239-1245</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract>Purpose
Open ileal pouch surgery leads to high rates of adhesive small-bowel obstruction (SBO). A laparoscopic approach may reduce these complications. We aimed to review the incidence of adhesive SBO-related complications after open pouch surgery and to model the potential financial impact of a laparoscopic approach purely as an adhesion prevention strategy.
Materials and Methods
We reviewed cases of open ileal pouch patients kept on a database and examined annually. Case notes were studied for episodes of adhesive SBO requiring admission or reoperation. Similar parameters were studied in a small series undergoing laparoscopic pouch surgery. The financial burden of the open access complications was estimated and potential financial impact of a laparoscopic approach modeled.
Results
Two hundred seventy-six patients were followed up after open surgery (median, 6.3; range, 0.2–20.1 years). There were 76 (28%) readmissions (median length of stay, 7.4 days) in 53 patients (19%) and 28 (10%) reoperations (43% within 1 year). Laparoscopic patients required less adhesiolysis at second-stage surgery (0% vs 36%,
p
< 0.0001) and had less SBO episodes within 12 months of surgery (0% vs 14%,
p
< 0.0001) than open patients. Modeling a laparoscopic approach cost $1,450 and saved $3,282, thus netting $1,832 per pouch constructed.
Conclusion
Open ileal pouch surgery results in significant cumulative long-term access-related complications, particularly adhesions. These impose a large medical burden on patients and financial burden on health-care systems, all of which may be recouped by a laparoscopic approach, despite higher theater costs.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>18278539</pmid><doi>10.1007/s11605-008-0481-3</doi><tpages>7</tpages></addata></record> |
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| ispartof | Journal of gastrointestinal surgery, 2008-07, Vol.12 (7), p.1239-1245 |
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| source | MEDLINE; SpringerNature Complete Journals |
| subjects | Adult Colonic Diseases - surgery Colonic Pouches - pathology Cost-Benefit Analysis Female Follow-Up Studies Gastroenterology Humans Ileal Diseases - epidemiology Ileal Diseases - etiology Ileal Diseases - prevention & control Incidence Intestinal Obstruction - epidemiology Intestinal Obstruction - etiology Intestinal Obstruction - prevention & control Laparoscopy - economics Laparoscopy - methods Male Medicine Medicine & Public Health Original Article Postoperative Complications Prognosis Prospective Studies Surgery Tissue Adhesions - economics Tissue Adhesions - epidemiology Tissue Adhesions - prevention & control United Kingdom - epidemiology |
| title | Adhesions are Common and Costly after Open Pouch Surgery |
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