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The Public Health Crisis in Emergency General Surgery: Who Will Pay the Price and Bear the Burden?

The Public Health Crisis in Emergency General Surgery: Who Will Pay the Price and Bear the Burden? Costs for emergency general surgery (EGS) currently exceed those of treating diabetes, myocardial infarctions, and new cancer diagnoses.1 What is now a national burden will soon become a crisis, with annual costs projected to reach more than $40 billion by 2060.2 Public health policy has been slow to address this looming catastrophe partly because the concept of “emergency general surgery” has been difficult to characterize and measure. In this month’s JAMA Surgery, Scott et al3 have attempted to formally define the operative procedures that account for the vast majority of surgical admissions. In an analysis of the National Inpatient Sample from 2008 to 2011, they identified a set of 7 operative EGS procedure groups that collectively account for approximately 80% of the morbidity, mortality, and costs associated with EGS procedures nationwide. These included partial colectomy, small-bowel resection, cholecystectomy, operative management of peptic ulcer disease, lysis of peritoneal adhesions, appendectomy, and laparotomy. Scott et al3 concluded that national quality benchmarks and cost reduction efforts should focus on these EGS procedures. This article3 adds important information to the growing body of literature attempting to identify opportunities for improving outcomes and reducing costs in the management of patients with intra-abdominal emergencies. It builds on the work of the American Association for the Surgery of Trauma that first standardized definitions and diagnosis codes for EGS. Where do we go from here? While this study3 has the limitations associated with using claims-derived data, the next step would be to monitor the outcomes of these 7 operative EGS procedures in prospective, clinically derived databases, particularly those procedures that Scott et al3 have defined as being associated with the highest rates of complications, such as emergency bowel resection and surgery for the acute complications of ulcer disease. As an example of this, a recent analysis of National Surgical Quality Improvement Program data by Scarborough et al4 found that the specific complications accounting for the greatest cost and morbidity in EGS patients were postoperative bleeding and postoperative pneumonia. Continued studies along these lines should provide direction for high-impact quality initiatives, emphasizing not just a reduction in complications but an earlier recognition of these particularly morbid adverse events. Also necessary are improved metrics for measuring the quality of the acute surgical care that is delivered, so that this can be better standardized across our health care system. Finally, national health policy needs to address the fact that we have a decreasing number of general surgeons facing a growing burden, and appropriate resources and strategic planning need to be directed toward correcting this. Back to top Article Information Corresponding Author: Martin G. Paul, MD, Sibley Memorial Hospital, Johns Hopkins Medicine, 5250 Loughboro Rd, Ste 300, Washington, DC 20016 (mpaul22@jhmi.edu). Published Online: April 27, 2016. doi:10.1001/jamasurg.2016.0640. Conflict of Interest Disclosures: None reported. References 1. Gale SC, Shafi S, Dombrovskiy VY, Arumugam D, Crystal JS. The public health burden of emergency general surgery in the United States: a 10-year analysis of the Nationwide Inpatient Sample—2001 to 2010. J Trauma Acute Care Surg. 2014;77(2):202-208.PubMedGoogle ScholarCrossref 2. Ogola GO, Gale SC, Haider A, Shafi S. The financial burden of emergency general surgery: national estimates 2010 to 2060. J Trauma Acute Care Surg. 2015;79(3):444-448.PubMedGoogle ScholarCrossref 3. Scott JW, Olufajo OA, Brat GA, et al. Use of national burden to define operative emergency general surgery [published online April 27, 2016]. JAMA Surg. doi:10.1001/jamasurg.2016.0480.Google Scholar 4. Scarborough JE, Schumacher J, Pappas TN, et al. Which complications matter most? prioritizing quality improvements in emergency general surgery. J Am Coll Surg. 2016;222(4):515-524.PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Surgery American Medical Association

The Public Health Crisis in Emergency General Surgery: Who Will Pay the Price and Bear the Burden?

JAMA Surgery , Volume 151 (6) – Jun 1, 2016

The Public Health Crisis in Emergency General Surgery: Who Will Pay the Price and Bear the Burden?

Abstract

Costs for emergency general surgery (EGS) currently exceed those of treating diabetes, myocardial infarctions, and new cancer diagnoses.1 What is now a national burden will soon become a crisis, with annual costs projected to reach more than $40 billion by 2060.2 Public health policy has been slow to address this looming catastrophe partly because the concept of “emergency general surgery” has been difficult to characterize and measure. In this month’s JAMA Surgery, Scott et...
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Publisher
American Medical Association
Copyright
Copyright © 2016 American Medical Association. All Rights Reserved.
ISSN
2168-6254
eISSN
2168-6262
DOI
10.1001/jamasurg.2016.0640
Publisher site
See Article on Publisher Site

Abstract

Costs for emergency general surgery (EGS) currently exceed those of treating diabetes, myocardial infarctions, and new cancer diagnoses.1 What is now a national burden will soon become a crisis, with annual costs projected to reach more than $40 billion by 2060.2 Public health policy has been slow to address this looming catastrophe partly because the concept of “emergency general surgery” has been difficult to characterize and measure. In this month’s JAMA Surgery, Scott et al3 have attempted to formally define the operative procedures that account for the vast majority of surgical admissions. In an analysis of the National Inpatient Sample from 2008 to 2011, they identified a set of 7 operative EGS procedure groups that collectively account for approximately 80% of the morbidity, mortality, and costs associated with EGS procedures nationwide. These included partial colectomy, small-bowel resection, cholecystectomy, operative management of peptic ulcer disease, lysis of peritoneal adhesions, appendectomy, and laparotomy. Scott et al3 concluded that national quality benchmarks and cost reduction efforts should focus on these EGS procedures. This article3 adds important information to the growing body of literature attempting to identify opportunities for improving outcomes and reducing costs in the management of patients with intra-abdominal emergencies. It builds on the work of the American Association for the Surgery of Trauma that first standardized definitions and diagnosis codes for EGS. Where do we go from here? While this study3 has the limitations associated with using claims-derived data, the next step would be to monitor the outcomes of these 7 operative EGS procedures in prospective, clinically derived databases, particularly those procedures that Scott et al3 have defined as being associated with the highest rates of complications, such as emergency bowel resection and surgery for the acute complications of ulcer disease. As an example of this, a recent analysis of National Surgical Quality Improvement Program data by Scarborough et al4 found that the specific complications accounting for the greatest cost and morbidity in EGS patients were postoperative bleeding and postoperative pneumonia. Continued studies along these lines should provide direction for high-impact quality initiatives, emphasizing not just a reduction in complications but an earlier recognition of these particularly morbid adverse events. Also necessary are improved metrics for measuring the quality of the acute surgical care that is delivered, so that this can be better standardized across our health care system. Finally, national health policy needs to address the fact that we have a decreasing number of general surgeons facing a growing burden, and appropriate resources and strategic planning need to be directed toward correcting this. Back to top Article Information Corresponding Author: Martin G. Paul, MD, Sibley Memorial Hospital, Johns Hopkins Medicine, 5250 Loughboro Rd, Ste 300, Washington, DC 20016 (mpaul22@jhmi.edu). Published Online: April 27, 2016. doi:10.1001/jamasurg.2016.0640. Conflict of Interest Disclosures: None reported. References 1. Gale SC, Shafi S, Dombrovskiy VY, Arumugam D, Crystal JS. The public health burden of emergency general surgery in the United States: a 10-year analysis of the Nationwide Inpatient Sample—2001 to 2010. J Trauma Acute Care Surg. 2014;77(2):202-208.PubMedGoogle ScholarCrossref 2. Ogola GO, Gale SC, Haider A, Shafi S. The financial burden of emergency general surgery: national estimates 2010 to 2060. J Trauma Acute Care Surg. 2015;79(3):444-448.PubMedGoogle ScholarCrossref 3. Scott JW, Olufajo OA, Brat GA, et al. Use of national burden to define operative emergency general surgery [published online April 27, 2016]. JAMA Surg. doi:10.1001/jamasurg.2016.0480.Google Scholar 4. Scarborough JE, Schumacher J, Pappas TN, et al. Which complications matter most? prioritizing quality improvements in emergency general surgery. J Am Coll Surg. 2016;222(4):515-524.PubMedGoogle ScholarCrossref

Journal

JAMA SurgeryAmerican Medical Association

Published: Jun 1, 2016

Keywords: postoperative complications,public health medicine,abdominal surgery,emergency abdominal surgery,gastrointestinal surgical procedures,general surgery

References