Table 1 Abstracted data from eligible studies

Shapter et al. 2012

UK

1 teaching hospital

2009–2010

Partial economic evaluation. Retrospective database analysis using HES codes for emergency laparotomy. Demographic process and outcome data for 2 years in Brighton.

768 (850 ELs)

Inpatient and 30-day mortalities (14 and 11%, respectively)

Cost of hospital stay

LOS, HRG codes, HES data extraction

13 (8–24) Median (IQR)

Cost per patient: median (IQR) €8434 (5700–15,103)

€2880 (2200–3840) Median (IQR) £16 per min theatre, 24% of total costs

€6910 (4146–15,202) Median (IQR) £1382 per day ICU, 30% of total costs

€3984 (2256–7050) Median (IQR) £282 per day ward bed, 46% of total costs

£650 m (England)

Murray et al. 2012

UK

35 NHS Hospitals

2012

Partial economic evaluation. Prospective national audit of emergency laparotomy patients.

1853

Cost of hospital stay, unadjusted in-hospital mortality

As per Shapter et al. 2012.

15 (9–27). Median (IQR)

Cost per patient: (median (IQR)) £9282 (£6222–£14,400). Cheapest 9 hospitals had a median cost of £7223 (£5418–£11,340); most expensive 9 hospitals were £11,904 (£8224–£17,192)

N/A

N/A

N/A

N/A

Menzies et al. 2001

UK

2 District general hospitals

1996–1997

Partial economic evaluation. Retrospective case review of emergency laparotomy for adhesions.

110 (41 treated surgically)

Cost of hospital stay, length of hospital/ICU stay, inpatient mortality

Costs calculated from financial department of each hospital

ICU 0.3 (0.8) Ward 16.3 (11) Mean (SD)

Cost per patient: (mean) £4677.41

£832 per episode, £8.67/min

£386 per day, mean per admission £1332

£180 per day, mean per admission £2941.2

N/A

Wilson et al. 1998

UK

1 University hospital

1990–1996

Partial economic evaluation. Retrospective case review of patients with acute bowel obstruction.

26

Direct hospital costs

Unclear how costs derived.

11 (range 2–47) for operative cases

£1964.83 median (no IQR provided)

£470.92 per episode Mean

N/A

£13,581 per 100 patients

N/A

Haider et al. 2015

USA

2001–2010

Partial economic evaluation. Retrospective database analysis. Included patient with elective and emergency surgery for AAA repair, CABG, colon resection for neoplasm. Nationwide Inpatient Sample (NIS) data used. 20% stratified sample, weighted to represent 95% of USA population. Multivariable logistic regression used to investigate the adjusted odds of mortality for elective and emergency cases.

621,925

Cost of hospital stay, length of stay, in hospital mortality

Costs calculated by multiplying total charge by hospital-specific all-payer cost-to-charge ratios. Healthcare cost and utilisation project-NIS discharge-level weights were applied to derive national patient estimates.

Significantly lower mean hospital length of stay for elective patients. All patients= 6.9 ± 5.8 vs. 10.6 ± 7.9 AAA repair = 5.2 ± 6.8 vs 11.1 ± 11.9 CABG = 7.4 ± 5.6 vs 10.3 ± 7.4 colon resection = 6.9 ± 5.2 vs 11.9 ± 7.8

Cost per patient: (mean) US$ 22,616.33 Cost difference for emergency vs. elective care was $8741.22 (30% increase) for AAA repair, $5309.78 (17% increase) for coronary artery bypass graft, and $7813.53 (53% increase) for colon resection.

N/A

N/A

N/A

if 10% of the weighted estimates of patients who underwent emergency procedures had instead been performed electively, the associated cost benefits were $996,169,160 (95% CI, 985,505,565–1,006,834,104)

Anantha et al. 2014

Canada

1 Hospital

2009–2010

Partial economic evaluation. Retrospective case-control. Pre- and post- analysis of emergency surgery patients following introduction of an Acute Care and Emergency Surgery Service (ACCESS)

366

Volume of emergency surgery and economic viability of service provision

Surgical billing costs

N/A

Cost per patient (“average”): Pre-pathway = US$ 767.94 Post-pathway = US$ 620.03

N/A

N/A

N/A

N/A

Ray et al. 1998

USA

National Hospital Discharge Survey database

1994

Partial economic evaluation. Retrospective database analysis of patients with adhesional intestinal obstruction. Hospitalisation costs estimated from 1994 medical provider analysis and review of inpatient expenditure, based on Medicare rates

303,836

Estimation of total number of adhesiolysis admissions in 1994.

Cost calculated according to Medicare records, procedure, diagnosis codes. Surgeon costs calculated from part B Medical Annual Data (BMAD) beneficiary file.

9.7

Daily cost per operative patient: (mean) $1266 per day

$837 per episode Mean

N/A

Admission costs: $1266 per day Mean

$1.3 billion in hospitalisation and surgeon expenditures. $1.1 billion attributed to digestive tract procedures.

Khaikin et al. 2007

USA Teaching hospital

1999–2005 (Economic data: 2002–2005)

Partial economic evaluation. Retrospective case review of patients with small bowel obstruction. Comparison of clinical and cost outcomes for laparoscopic vs. open treatment of small bowel obstruction.

62 (31 laparotomy)

Cost of hospital stay, in hospital morbidity (pulmonary, cardiac complications etc.)

Very limited detail. Financial records system used.

Laparotomy = 13 (45% morbidity) Laparoscopic = 7 days (16% morbidity) Mean

Total costs (NB: not per patient): (mean) Laparotomy = $61,855.68 Laparoscopic = $39,866.87

Laparotomy = $11,819.92 Laparoscopic = $9972.07 Mean

N/A

N/A

N/A

Opmeer et al. 2010

Netherlands

2 Academic and 5 regional teaching hospitals

2001–2005

Full economic evaluation and cost minimisation analysis. Randomised controlled trial (re-laparotomy on demand vs. scheduled). Included patients with emergency laparotomy, severe peritonitis. Compare patient outcomes, health care utilisation and societal cost over 1 year of on-demand vs. planned re-laparotomy).

229 (114 on demand; 115 planned)

Cost of hospital stay, cost after discharge to 1 year after index operation (i.e. societal costs)

Financial records for resource utilisation. Direct and indirect (loss of productivity) costs included.

On demand = 38 Planned = 45 Mean

Cost per patient (mean) On demand group = €65,768 Planned group = €83,450 Mean absolute difference of €17,682 [95%CI €5602–€29,004])

N/A

Total ICU costs (NB, not per day): On demand = €21,040 Planned = €31,248 Mean

Total ward costs (NB, not per day): On demand = €11,609 Planned = €11,748 Mean

Extrapolated savings of €10 million by using an on demand approach (21% reduction in costs)

Kössi et al. 2004

Finland

1 university and 4 regional hospitals

1999

Partial economic evaluation. Retrospective case review of patients with adhesional intestinal obstruction. Assessment of surgical workload and direct costs of inpatient care relating to cases caused by previous colorectal surgery.

123 (40 treated surgically)

Cost of hospital stay, length of stay

Cost calculated from hospital specific expenses reported by financial departments Converted to US$ at 1999 rate

7 (SEM 0.6)

Unable to extract data on total cost for emergency laparotomy patients only.

Division of adhesions = $557.50 Adhesiolysis and bowel resection = $1613.50 Mean

N/A

N/A

N/A

Tingstedt et al. 2007

Sweden

1 University hospital

1987–1992

Partial economic evaluation. Retrospective case review of patients with adhesional intestinal obstruction, undergoing surgery. Total cost reported are for treating intra-abdominal adhesions—not specified whether patients received emergency laparotomy.

102

Cost of hospital stay, length of stay, societal cost of sick leave

Cost calculated, but source of data not referenced. Sick-leave days retrieved from medical records. Sick leave costs obtained from National Social Insurance Office

N/A Total duration of hospital days over 10 year follow up: 14 (4–163) Median (IQR)

Cost per patient: (mean) €6702 Other costs: Outpatient episode cost = €180 per patient Loss of production cost = total of €366,782

N/A

€1152.29 Mean

N/A

€39.9–59.5 million

Rossi et al. 2006

Italy

51 Hospitals

1999–2000

Partial economic evaluation. Retrospective case review of patients with adhesional intestinal obstruction, undergoing “Major abdominal surgery”. Does not explicitly define as emergency laparotomy.

1034 (28 unscheduled major abdominal surgery patients)

Cost of ICU stay, length of ICU stay

Cost calculated from ICU-specific expenses reported as prices paid or national costs for investigational procedures

N/A

N/A

N/A

Total ICU cost (NB, not per day): €3529 (3854) Mean (SD) Mean cost was comprised of variable costs associated with drugs (21.7%), nutrition (4.5%), infusions including blood and blood products (41.6%) consumables (6.4%), imaging (3.9%), laboratory tests (20.2%) and physician consultations (1.5%)

N/A

N/A

Kössi et al. 2003

Finland

1 university and 4 regional hospitals

1999

Partial economic evaluation. Retrospective case review of patients with adhesional intestinal obstruction. Assessment of surgical workload and direct costs of inpatient care.

138 (40 treated surgically)

Annual direct hospital costs

Cost calculated from hospital specific expenses reported by financial departments Converted to £ at 1999 rate

11 (2–34) for surgical patients Median (IQR)

Annual total direct hospital costs (NB: not per patient): £181,653

N/A

N/A

N/A

£2.1 million

Ivarsson et al. 1997

Sweden

1 University hospital

1997

Partial economic evaluation. Prospective observational study of patients with adhesional bowel obstruction.

57

Direct hospital costs

Costs calculated from financials records of hospital. Rehabilitation costs based upon council charges and time required. Sick leave charges.

N/A

Cost per patient (mean): Medical care: US$4999.03 Total expenditure: US$5694.12

N/A

N/A

N/A

Extrapolation of costs to Sweden from admission estimates: $13 million pa

Alwan et al. 1999

New Zealand

1 Teaching hospital

1988–1996 Only cost analysed for cases between 1993 and 1996

Partial economic evaluation. Retrospective case review of patients with adhesional intestinal obstruction.

332 (253 treated surgically)

Resource implications of managing small bowel obstruction

Costs calculated by LOS × daily hotel costs, investigation costs, support services, medical staff anaesthesia and operating theatre costs. Adjusted to 1996.

10 (4–18) Median (IQR)

Cost per patient (mean) NZ$7630 (2038–135,173) Daily cost per operative patient: NZ$1264 ($803–3741) per day

N/A

N/A

N/A

N/A

Koh et al. 2013

Singapore

1 University teaching hospital

2006–2011

Partial economic evaluation. Retrospective case-control review of all patients undergoing emergency laparoscopic colectomies, matched with open colectomies.

46

Cost of hospital stay, length of stay, complications

Financial records for resource utilisation

Laparotomy = 7 (3–31) Laparoscopic = 6 (3–28) Median (IQR)

Cost per patient: Median (IQR) Laparotomy = US$ 11,300 ($5080 -$33,530); Laparoscopic = US$12,360 ($6590–40,920)

Laparotomy = $3500 ($3000–$8580) Laparoscopic = $4050 ($3220–$8420) Median (IQR)

N/A

N/A

N/A