Bedside Small-Bowel Challenge vs. Fluoroscopic Series for SBO: A Cost Effectiveness Analysis

Area of Science:

• Medical Imaging
• Surgical Gastroenterology
• Health Services Research

Background:

• Small bowel obstruction (SBO) is a common cause of surgical hospital admissions, with potential for severe complications like bowel ischemia.
• Traditional diagnostic methods, such as the fluoroscopic small bowel series, require patient transport to the Radiology Department (RD), consuming valuable resources and time.
• The Small Bowel Challenge Exam presents a novel bedside alternative for SBO diagnosis.

Purpose of the Study:

• To evaluate the efficacy and efficiency of the Small Bowel Challenge Exam compared to the traditional fluoroscopic small bowel series.
• To analyze the impact of the Small Bowel Challenge Exam on hospital resource utilization, overall costs, and length of stay for SBO patients.

Main Methods:

• A retrospective analysis of 85 patients diagnosed with SBO between January 2018 and December 2023.
• Comparison of patients undergoing the traditional fluoroscopic series (n=37) versus the bedside Small Bowel Challenge Exam (n=48).
• Analysis of key metrics including hospital resource utilization, total costs, core costs, variable costs, and length of stay.

Main Results:

• The Small Bowel Challenge Exam group demonstrated significantly lower core costs (USD 389.6 vs. USD 615; p < 0.0001).
• Median total costs were lower in the challenge group (USD 1243 vs. USD 1472), with significant reduction when excluding CT scan costs (USD 993.5 vs. USD 1270; p = 0.0500).
• No significant differences were observed in length of stay, variable costs, or the frequency of additional imaging (CT scans or XR exams) between the two groups.

Conclusions:

• The Small Bowel Challenge Exam is an efficient alternative that reduces specific hospital costs and logistical burdens associated with SBO diagnosis.
• This bedside approach does not negatively impact patient length of stay, indicating optimized resource utilization.
• Further research is warranted to explore broader implementation and assess the long-term clinical and economic impacts of the Small Bowel Challenge Exam.