Stephen C. Gale

The public health burden of emergency general surgery in the United States: A 10-year analysis of the Nationwide Inpatient Sample--2001 to 2010.

BACKGROUND Emergency general surgery (EGS) represents illnesses of very diverse pathology related only by their urgent nature. The growth of acute care surgery has emphasized this public health problem, yet the true “burden of disease” remains unknown. Building on efforts by the American Association for the Surgery of Trauma to standardize an EGS definition, we sought to describe the burden of disease for EGS in the United States. We hypothesize that EGS patients represent a large, diverse, and challenging cohort and that the burden is increasing. METHODS The study population was selected from the Nationwide Inpatient Sample, 2001 to 2010, using the AAST EGS DRG International Classification of Diseases—9th Rev. codes, selecting all EGS patients 18 years or older with urgent/emergent admission status. Rates for operations, mortality, and sepsis were compiled along with hospital type, length of stay, insurance, and demographic data. The &khgr;2 test, the t test, and the Cochran-Armitage trend test were used; p < 0.05 was significant. RESULTS From 2001 to 2010, there were 27,668,807 EGS admissions, 7.1% of all hospitalizations. The population-adjusted case rate for 2010 was 1,290 admissions per 100,000 people (95% confidence interval, 1,288.9–1,291.8). The mean age was 58.7 years; most had comorbidities. A total of 7,979,578 patients (28.8%) required surgery. During 10 years, admissions increased by 27.5%; operations, by 32.3%; and sepsis cases, by 15% (p < 0.0001). Mortality and length of stay both decreased (p < 0.0001). Medicaid and uninsured rates increased by a combined 38.1% (p < 0.0001). Nearly 85% were treated in urban hospitals, and nearly 40% were treated in teaching hospitals; both increased over time (p < 0.0001). CONCLUSION The EGS burden of disease is substantial and is increasing. The annual case rate (1,290 of 100,000) is higher than the sum of all new cancer diagnoses (all ages/types): 650 per 100,000 (95% confidence interval, 370.1–371.7), yet the public health implications remain largely unstudied. These data can be used to guide future research into improved access to care, resource allocation, and quality improvement efforts. LEVEL OF EVIDENCE Epidemiologic study, level III.

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

Creation of an emergency surgery service concentrates resident training in general surgical procedures.

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

Organization and Operations Management at the Health Care Facility

10,615–

Impact of transfer distance and time on rural brain injury outcomes.

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

Enhancing the tissue donor pool through donation after death in the field.

28.37 billion (95% CI,

Injury patterns and outcomes in late middle age (55–65): The intersecting comorbidity with high-risk activity – A retrospective cohort study

28.03–

Contemporary management of rectal injuries at Level i trauma centers: The results of an American Association for the Surgery of Trauma multi-institutional study

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

Medical Management at the Health Care Facility

8.03 billion for age ≥ 75 years, compared with

Poor glycemic control is associated with increased mortality in critically ill trauma patients.

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