title: Nonoperative management of adhesive small bowel obstruction: what is the break point?
abstract: BACKGROUND
  The current management paradigm for recurrent adhesive small bowel obstruction (SBO) is nonoperative. Rates of recurrence differ based on time interval between and number of previous occurrences. Optimal time to intervene has not been determined.
  
  
  METHODS
  We constructed a Markov model to evaluate costs and quality of life on a hypothetical cohort of 40-year-old patients after their first episode of medical management for postoperative SBO. We estimated a relative risk reduction of .55 with surgical intervention and a relative risk increase of 2.1, 2.9, and 5.7 after the medical management of the 2nd, 3rd, and 4th SBO.
  
  
  RESULTS
  Surgery performed after earlier episodes of SBO was more costly but also more effective. The cost difference between surgery after the 1st SBO recurrence vs the 2nd SBO recurrence was $1,643, with an increase of .135 quality-adjusted life years (QALYs), the incremental cost-effectiveness ratio was $12,170 per QALY.
  
  
  CONCLUSIONS
  Surgery after the first episode of SBO provides a small increase in QALY at a small cost since surgical intervention lowers the risk of recurrence.
authors: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA. Electronic address: Alexander.Colonna@hsc.utah.edu.
authors: Alexander L
authors: AL
authors: Colonna
authors: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors: Nickolas R
authors: NR
authors: Byrge
authors: Department of Pharmacy, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
authors: Scott D
authors: SD
authors: Nelson
authors: Department of Pharmacy, School of Medicine, University of Utah, Salt Lake City, UT, USA.
authors: Richard E
authors: RE
authors: Nelson
authors: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors: Michael C
authors: MC
authors: Hunter
authors: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors: Raminder
authors: R
authors: Nirula
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017048:Health Care Costs; D006801:Humans; D007415:Intestinal Obstruction / Q000191:economics / Q000209:etiology / Q000628:therapy*; D007421:Intestine, Small; D008390:Markov Chains; D008962:Models, Theoretical; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology / Q000628:therapy*; D011788:Quality of Life; D012008:Recurrence; D000267:Tissue Adhesions / Q000191:economics / Q000209:etiology / Q000628:therapy*
keywords: Adhesions; Cost effectiveness; Quality-adjusted life years; Small bowel obstruction