Inpatient Economic Burden of Postoperative Ileus Associated with Abdominal Surgery in the United States

pain, nausea, vomiting, and the inability to advance the diet during the postoperative period. Complications of POI include atelectasis and pneumonia. If POI is prolonged, poor wound healing can result, in part, from nutritional deficits. Although the duration of POI is partially dependent on the extent of surgical manipulation, the surgical site, and patient characteristics, a delay in return to normal bowel function beyond three days after surgery is considered prolonged and, as such, is clinically relevant. Current management strategies consist of careful selection of anesthesia and analgesia before, during, and after surgery to minimize the duration of POI and the use of supportive therapies such as enteral nutrition, intravenous fluids, reversal of electrolyte or metabolic abnormalities, and pharmacological agents (e.g., laxatives and prokinetic drugs). However, these strategies are not uniformly successful, and patients are often slow to respond to them. In addition to substantial patient morbidity, POI is a major cause of increased usage of hospital resources, because discharge after surgery is typically delayed until the patient can tolerate a regular diet and acceptable bowel function is restored. In a retrospective chart review of cystectomy procedures, almost 23% of patients had ileus lasting more than four days; 78% of these patients had prolonged POI lasting more than eight days. In addition, a recent retrospective analysis demonstrated that patients with POI that was coded as such during their index hospitalization for various surgical procedures had a significantly longer LOS of two to three days than did patients without coded POI. Beyond prolonged hospital LOS during the index hospitalization, patients are also at higher risk for hospital readmission because of postoperative dysmotility. Based on recent publications, approximately 10% of patients undergoing major abdominal surgery were readmitted within 30 days, and one third were readmitted for small-bowel obstruction or ileus. Despite the substantial level of morbidity associated with POI, the aggregate clinical and economic consequences resulting from POI and its complications have not been well studied, possibly because of the lack of available therapeutic options ABSTRACT A study was conducted to estimate the economic burden of postoperative ileus (POI) to the U.S. hospital system. Using national data projected from a large, inpatient, service-level, comparative database and applying hospitalization costs, we determined direct inpatient costs attributable to POI. Our results indicated that hospitalization for coded POI, according to the International Classification of Diseases, ninth revision (ICD-9), was substantially more costly ($18,877 vs. $9,460) and longer (11.5 vs. 5.5 days) than hospitalization for non-coded POI. Total annual costs attributed to managing POI were $1.46 billion, a situation thus warranting increased attention.