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Seven Emergency Surgical Procedures Account for 80% of Costs, Deaths

Expert sees “looming catastrophe”

As the costs of emergency surgery soar, new research published in JAMA Surgery has found that just seven procedures account for 80% of admissions, inpatient costs, complications, and deaths. In a separate commentary, Martin G. Paul, MD, of Johns Hopkins Medicine, wrote that the situation is a “looming catastrophe” as the annual cost of emergency procedures is expected to exceed $40 billion by 2060.

Researchers conducted a retrospective review using data from the 2008–2011 National Inpatient Sample. The analysis included adults (18 years of age or older) with primary emergency general surgery (EGS) diagnoses consistent with the American Association for the Surgery of Trauma (AAST) definition, admitted urgently or emergently, who underwent an operative procedure within two days of admission. Surgical procedures were ranked to account for national mortality and complication burden. Among ranked procedures, contributions to total EGS frequency, mortality, and hospital costs were assessed. The main outcome measures included overall procedure frequency, in-hospital mortality, major complications, and inpatient costs calculated per three-digit International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes.

The study identified 421,476 patient encounters associated with operative EGS, weighted to represent 2.1 million nationally over the four-year study period. The overall mortality rate was 1.2%; the complication rate was 15.0%; and the mean cost per admission was $13,241.

After ranking the 35 procedure groups by their contributions to EGS mortality and morbidity burden, a final set of seven operative EGS procedures was identified, which collectively accounted for 80.0% of procedures, 80.3% of deaths, 78.9% of complications, and 80.2% of inpatient costs nationwide. These seven procedures included partial colectomy, small-bowel resection, cholecystectomy, operative management of peptic ulcer disease, lysis of peritoneal adhesions, appendectomy, and laparotomy.

The researchers concluded that health care professionals would benefit from looking at quality benchmarks and cost-cutting strategies for those seven procedures.

“Given their high prevalence nationally and high proportion of  burden they represent… the seven procedures identified in this study could lead to better clinical decision-making, patient outcomes, and cost savings,” the team wrote.

Sources: JAMA Surgery; April 27, 2016; and FierceHealthcare; April 28, 2016.

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