The Economic Footprint of Acute Care Surgery in the United States: Implications for Systems Development. The journal of trauma and acute care surgery Knowlton, L. M., Minei, J., Tennakoon, L., Davis, K. A., Doucet, J., Bernard, A., Haider, A., Tres Scherer, L. R., Spain, D. A., Staudenmayer, K. L. 2018


BACKGROUND: Acute Care Surgery (ACS) comprises Trauma, Surgical Critical Care, and Emergency General Surgery (EGS), encompassing both operative and non-operative conditions. While the burden of EGS and trauma have been separately considered, the global footprint of ACS has not been fully characterized. We sought to characterize the costs and scope of influence of ACS-related conditions. We hypothesized that ACS patients comprise a substantial portion of the U.S. inpatient population. We further hypothesized that ACS patients differ from other surgical and non-surgical patients across patient characteristics METHODS: We queried the National Inpatient Sample (NIS) 2014, a nationally representative database for inpatient hospitalizations. In order to capture all adult ACS patients, we included adult admissions with any ICD-9-CM diagnosis of trauma or an ICD-9-CM diagnosis for one of the 16 AAST-defined EGS conditions. Weighted patient data were presented to provide national estimates.RESULTS: Of the 29.2 million adult patients admitted to U.S. hospitals, approximately 5.9 million (20%) patients had an ACS diagnosis. ACS patients accounted for $85.8 billion dollars, or 25% of total U.S. inpatient costs ($341 billion). When comparing ACS to non-ACS inpatient populations, ACS patients had higher rates of healthcare utilization with longer lengths of stay (5.9 vs. 4.5 days, p<0.001), and higher mean costs ($14,466 vs. $10,951, p<0.001. Of all inpatients undergoing an operative procedure, 27% were patients with an ACS diagnosis. Overall, 3,186 (70%) of U.S. hospitals cared for both trauma and EGS patients.CONCLUSION: Acute care surgery patients comprise 20% of the inpatient population, but 25% of total inpatient costs in the U.S. In addition to being costly, they overall have higher healthcare utilization and worse outcomes. This suggests there is an opportunity to improve clinical trajectory for ACS patients that in turn, can affect the overall U.S. healthcare costs.Epidemiologic, level III.

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