Gerald Ogola

The financial burden of emergency general surgery: National estimates 2010 to 2060.

BACKGROUND Adoption of the acute care surgery model has led to increasing volumes of emergency general surgery (EGS) patients at trauma centers. However, the financial burden of EGS services on trauma centers is unknown. This study estimates the current and future costs associated with EGS hospitalization nationwide. METHODS We applied the American Association for the Surgery of Trauma’s DRG International Classification of Diseases—9th Rev. criteria for defining EGS to the 2010 National Inpatient Sample (NIS) data and identified adult EGS patients. Cost of hospitalization was obtained by converting reported charges to cost using the 2010 all-payer inpatient cost-to-charge ratio for all hospitals in the NIS database. Cost was modeled via a log-gamma model in a generalized linear mixed model to account for potential correlation in cost within states and hospitals in the NIS database. Patients’ characteristics and hospital factors were included in the model as fixed effects, while state and hospital were included as random effects. The national incidence of EGS was calculated from NIS data, and the US Census Bureau population projections were used to estimate incidence for 2010 to 2060. Nationwide costs were obtained by multiplying projected incidences by estimated costs and reported in year 2010 US dollar value. RESULTS Nationwide, there were 2,640,725 adult EGS hospitalizations in 2010. The national average adjusted cost per EGS hospitalization was

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10,744 (95% confidence interval [CI],

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10,615–

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10,874); applying these cost data to the national EGS hospitalizations gave a total estimated cost of

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28.37 billion (95% CI,

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28.03–

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28.72 billion). Older age groups accounted for greater proportions of the cost (

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8.03 billion for age ≥ 75 years, compared with

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1.08 billion for age 18–24 years). As the US population continues to both grow and age, EGS costs are projected to increase by 45% to

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41.20 billion (95% CI,