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

## TL;DR

This study compares a bedside exam to a traditional radiology test for small bowel obstruction, finding the new method saves costs without increasing hospital stays.

## Contribution

The study introduces a cost-effective bedside alternative to fluoroscopic series for diagnosing small bowel obstruction.

## Key findings

- The Small Bowel Challenge Exam reduced core costs significantly compared to traditional fluoroscopic series.
- Length of stay and variable costs were not significantly different between the two groups.
- The new method did not increase the need for additional imaging.

## Abstract

Background: Small bowel obstruction (SBO) accounts for 12–16% of surgical hospital admissions and can lead to complications such as bowel ischemia. Traditional management requires transporting patients to the Radiology Department (RD) for a fluoroscopic small bowel series, occupying resources and time. This study evaluates the efficacy and efficiency of the Small Bowel Challenge Exam, a bedside alternative. Methods: A retrospective analysis was performed on 85 SBO patients from January 2018 to December 2023 at an academic tertiary care facility, comparing the traditional fluoroscopic series (37 patients) to the bedside Small Bowel Challenge Exam (48 patients). Key metrics analyzed included hospital resource utilization, overall costs, and length of stay. Results: Gender and race distributions were similar between groups (p = 0.268 and p = 0.808, respectively). Median total costs were lower in the challenge group (USD 1243 vs. USD 1472; p = 0.1229), significantly so when excluding CT scan costs (USD 993.5 vs. USD 1270; p = 0.0500). Core costs also significantly favored the challenge group (USD 389.6 vs. USD 615; p < 0.0001). Length of stay and variable costs showed no significant differences (p = 0.3846 and p = 0.8065, respectively). Additional imaging frequencies were comparable (p = 0.96 for CT scans; p = 0.97 for XR exams). Conclusions: The Small Bowel Challenge Exam reduces certain costs and logistical burdens without prolonging length of stay, suggesting more efficient use of hospital resources. Further research is recommended to evaluate broader implementation and long-term impacts.