In a latest research published in JAMA Network on May 3rd, 2016, the researchers allude to the looming crisis in the public health policy. Michael McCarthy, the author of the publication, believes that lest early interventions are made, the emergency general surgery (EGC), on account of its high cost, may soon convert from being national burden into a crisis.

The EGS, representing 11% of surgical admissions and 50% of surgical mortality, costs more than $6 billion in the United States. Of all the surgical procedures performed in a hospital, seven constitute 80% of the emergency surgical operations, 78.9% of all complications linked with surgeries, and 80.3% of all the deaths. These include the following:

Colectomy — surgical removal of all or part of the colon (partial colectomy)

Small bowel resection – surgical excision of small intestines

Cholecystectomy – surgical removal of gall bladder

Operative management of peptic ulcer disease

Lysis of peritoneal adhesions – fibrous tissue that connects abdominal organs to each other or to the wall of the abdomen

Appendectomy– surgical removal of the appendix to resolve appendix pain

Laparotomy – surgical procedure to gain access to the abdominal cavity

Each year more than 500,000 people undergo emergency general surgery in the US adding to the cost of an already burgeoning national burden. Cost reduction of the emergency surgeries is imperative otherwise, the researchers warn, the burden can magnify into a crisis of great proportions. The annual cost of emergency general surgeries is expected to exceed $40 billion by 2060.

The research concluded that quality initiatives in the public health policy are the need of the hour to curb the risk of the looming catastrophe. Such initiatives would not only lower the cost of the procedures but will also help reduce the complications associated with these procedures.

Earlier this year, a similar retrospective study, conducted by Scott JW and colleagues, was published in JAMA that pressed on the need for the development of cost reduction efforts focusing on the costly, and sometimes deadly, EGS procedures.

Study Design

In the retrospective study, the data from the National Inpatient Sample – a database for hospital admissions – was analyzed from 2008 to 2011. It included well over 3.1 million patients treated over these years. All patients were 18 years or older and were admitted emergently into the hospital for a surgery. The patients were treated either the same day or within two days of admission. The surgical procedures were ranked, and frequency, mortality and cost of all the ranked procedures were assessed.

Results

The retrospective analysis included 421,476 patients who underwent various surgical procedures. The mean cost per admission was $13,241, overall mortality rate was 1.23%, and the complication rate was 15%. The review ranked a total of 35 procedures and after careful evaluation, seven out of these 35 were identified to have the highest frequency. These procedures, as listed above, accounted for 80% of the surgical procedures, 80.3% of deaths, 78.9% of complications, and 80.2% of inpatient costs nationwide.

Discussion

The latest research warns of the impending crisis in the US public health. For starters, it has been the first study to use a nationally representative sample which authenticates its findings regarding the identification of the EGS procedures, their frequency, costs and the complications and deaths associated with them.

Second, of the 621 surgical procedures performed in the hospital surgery, the current review was able to identify the seven most commonly performed surgical procedures that alone cost more than the treatment for cardiovascular diseases, diabetes, and new cancer diagnosis. These seven procedures account for more than 80% of the burden of the operative emergency general surgery. This list of procedures, the study concluded, provides a relevant and appropriate starting point for efforts to improve quality of public health policy, reduce cost of the procedures and set new national benchmarks for emergency general surgery in the country.

 Study Limitations

The study was retrospective and relied mainly on the claims data, warranting future, prospective studies to subsequently monitor and strengthen its findings.

The analysis excluded the non-operative patients from its final data set. Such an exclusion may have removed an important cohort of the patient that may not require a surgery but may otherwise require services of a surgeon.

About Emergency General Surgery (EGS)

Revolving around the care of acutely ill and highest-risk patients, the emergency general surgery (EGS) constitutes the costliest branch of medicine. Each year in the US, more than three million patients are admitted to the hospital for EGS – that’s more than the sum of all new cancer diagnoses. Compared to the patients undergoing same procedure electively, the risk of post-operative death is eight times more in patients undergoing emergency surgery. Likewise, there are strong chances that half of all patients undergoing EGC will develop a postoperative complication. Of them, 15% require a readmission.