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Table 1 Abstracted data from eligible studies

From: A systematic review and overview of health economic evaluations of emergency laparotomy

Author, Year Context Year of data collection Methodology Sample size Outcome measures Costs calculated by Length of stay; days Total cost per inpatient episode Total cost per theatre episode ICU costs Ward costs Annual national costs CHEC-list (max. 19)
UK
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) 9
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 5
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 9
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 5
US and Canada
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 $996,169,160 (95% CI, 985,505,565–1,006,834,104) 10
Anantha et al. 2014 Canada 1 Hospital 2009–2010 Partial economic evaluation. Retrospective case-control. Pre- and post- analysis of emergency surgery patients following introduction of an Acute Care and Emergency Surgery Service (ACCESS) 366 Volume of emergency surgery and economic viability of service provision Surgical billing costs N/A Cost per patient (“average”): Pre-pathway = US$ 767.94 Post-pathway = US$ 620.03 N/A N/A N/A N/A 9
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. 7
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 = $9972.07 Mean N/A N/A N/A 1
Europe
Opmeer et al. 2010 Netherlands 2 Academic and 5 regional teaching hospitals 2001–2005 Full economic evaluation and cost minimisation analysis. Randomised controlled trial (re-laparotomy on demand vs. scheduled). Included patients with emergency laparotomy, severe peritonitis. Compare patient outcomes, health care utilisation and societal cost over 1 year of on-demand vs. planned re-laparotomy). 229 (114 on demand; 115 planned) Cost of hospital stay, cost after discharge to 1 year after index operation (i.e. societal costs) Financial records for resource utilisation. Direct and indirect (loss of productivity) costs included. On demand = 38 Planned = 45 Mean Cost per patient (mean) On demand group = €65,768 Planned group = €83,450 Mean absolute difference of €17,682 [95%CI €5602–€29,004]) N/A Total ICU costs (NB, not per day): On demand = €21,040 Planned = €31,248 Mean Total ward costs (NB, not per day): On demand = €11,609 Planned = €11,748 Mean Extrapolated savings of €10 million by using an on demand approach (21% reduction in costs) 17
Kössi et al. 2004 Finland 1 university and 4 regional hospitals 1999 Partial economic evaluation. Retrospective case review of patients with adhesional intestinal obstruction. Assessment of surgical workload and direct costs of inpatient care relating to cases caused by previous colorectal surgery. 123 (40 treated surgically) Cost of hospital stay, length of stay Cost calculated from hospital specific expenses reported by financial departments Converted to US$ 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 8
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 7
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 7
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 8
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 6
Rest of the world
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 ($803–3741) per day N/A N/A N/A N/A 8
Koh et al. 2013 Singapore 1 University teaching hospital 2006–2011 Partial economic evaluation. Retrospective case-control review of all patients undergoing emergency laparoscopic colectomies, matched with open colectomies. 46 Cost of hospital stay, length of stay, complications Financial records for resource utilisation Laparotomy = 7 (3–31) Laparoscopic = 6 (3–28) Median (IQR) Cost per patient: Median (IQR) Laparotomy = US$ 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 7