{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T13:51:52Z","timestamp":1774533112381,"version":"3.50.1"},"reference-count":19,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2019,9,25]],"date-time":"2019-09-25T00:00:00Z","timestamp":1569369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,9,25]],"date-time":"2019-09-25T00:00:00Z","timestamp":1569369600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2019,9,25]],"date-time":"2019-09-25T00:00:00Z","timestamp":1569369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Adhesive small bowel obstruction (ASBO) severity has been associated with important clinical outcomes. However, the impact of ASBO severity on hospitalization cost is unknown. The American Association for the Surgery of Trauma (AAST) developed an Emergency General Surgery (EGS) disease severity grading system for ASBO. We stratified patients\u2019 ASBO severity and captured hospitalization costs hypothesizing that increased disease severity would correlate with greater costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a single\u2010center study of hospitalized adult patients with SBO during 2015\u20132017. Clinical data and estimated total cost (direct\u2009+\u2009indirect) were abstracted. AAST EGS grades (I\u2013IV) stratified disease severity. Costs were normalized to the median grade I cost. Univariate and multivariate analyses evaluated the relationship between normalized cost and AAST EGS grade, length of hospital and ICU stay, operative time, and Charlson comorbidity index.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 214 patients; 119 (56%) were female. AAST EGS grades included: I (62%, <jats:italic>n<\/jats:italic>\u2009=\u2009132), II (23%, <jats:italic>n<\/jats:italic>\u2009=\u200949), III (7%, <jats:italic>n<\/jats:italic>\u2009=\u200916), and IV (8%, <jats:italic>n<\/jats:italic>\u2009=\u200917). Relative to grade I, median normalized cost increased by 1.4\u2010fold for grade II, 1.6\u2010fold for grade III, and 4.3\u2010fold for grade IV disease. No considerable differences in patient comorbidity between grades were observed. Pair\u2010wise comparisons demonstrated that grade I disease cost less than higher grades (corrected <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Non\u2010operative management was associated with lower normalized cost compared to operative management (1.1 vs. 4.5, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). In patients who failed non\u2010operative management, normalized cost was increased 7.2\u2010fold. Collectively, the AAST EGS grade correlated well with cost (Spearman's <jats:italic>p<\/jats:italic>\u2009=\u20090.7, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). After adjustment for covariates, AAST EGS grade maintained a persistent relationship with cost.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Increasing ASBO severity is independently associated with greater costs. Efforts to identify and mitigate costs associated with this burdensome disease are warranted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>III, economic\/decision.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-019-05148-y","type":"journal-article","created":{"date-parts":[[2019,10,30]],"date-time":"2019-10-30T16:34:27Z","timestamp":1572453267000},"page":"3027-3034","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Disease Severity and Cost in Adhesive Small Bowel Obstruction"],"prefix":"10.1002","volume":"43","author":[{"given":"Matthew C.","family":"Hernandez","sequence":"first","affiliation":[{"name":"Division of Trauma, Critical Care and General Surgery, St. Mary's Hospital Mayo Clinic Mary Brigh 2\u2010810, 1216 Second Street SW 55902 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric J.","family":"Finnesgard","sequence":"additional","affiliation":[{"name":"Mayo Clinic School of Medicine Mayo Clinic Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omair A.","family":"Shariq","sequence":"additional","affiliation":[{"name":"Division of Trauma, Critical Care and General Surgery, St. Mary's Hospital Mayo Clinic Mary Brigh 2\u2010810, 1216 Second Street SW 55902 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ariel","family":"Knight","sequence":"additional","affiliation":[{"name":"Division of Trauma, Critical Care and General Surgery, St. Mary's Hospital Mayo Clinic Mary Brigh 2\u2010810, 1216 Second Street SW 55902 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Stephens","sequence":"additional","affiliation":[{"name":"Division of Trauma, Critical Care and General Surgery, St. Mary's Hospital Mayo Clinic Mary Brigh 2\u2010810, 1216 Second Street SW 55902 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johnathon M.","family":"Aho","sequence":"additional","affiliation":[{"name":"Division of Trauma, Critical Care and General Surgery, St. Mary's Hospital Mayo Clinic Mary Brigh 2\u2010810, 1216 Second Street SW 55902 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian D.","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Trauma, Critical Care and General Surgery, St. Mary's Hospital Mayo Clinic Mary Brigh 2\u2010810, 1216 Second Street SW 55902 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry J.","family":"Schiller","sequence":"additional","affiliation":[{"name":"Division of Trauma, Critical Care and General Surgery, St. Mary's Hospital Mayo Clinic Mary Brigh 2\u2010810, 1216 Second Street SW 55902 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin D.","family":"Zielinski","sequence":"additional","affiliation":[{"name":"Division of Trauma, Critical Care and General Surgery, St. Mary's Hospital Mayo Clinic Mary Brigh 2\u2010810, 1216 Second Street SW 55902 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,9,25]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1072\u20107515(97)00127\u20100"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017\u2010018\u20100163\u20108"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2016.0480"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017\u2010016\u20100109\u2010y"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001127"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001736"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010018\u20104671\u20101"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010003\u20101662\u2010x"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.18401"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.5248"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5634"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.2147\/CEOR.S167741"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001861"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1067\/msy.2001.116918"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2015.03.054"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000787"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000911"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13304\u2010018\u20100534\u20104"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468\u20101253(19)30016\u20100"}],"container-title":["World 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September 2019","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"All the authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}