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‘Looming catastrophe’: These 7 emergency surgeries account for 80 percent of deaths and costs

(David Goldman/AP)

Chances are that even the lucky among us will see the inside of an emergency room at some point, for ourselves or our loved ones. More than 3 million such patients undergo a surgical procedure each year in the United States, and the costs of this care are soaring to the point where they have overtaken the costs of treating diabetes, heart attacks and new cancer diagnoses.

Martin G. Paul, a doctor at Johns Hopkins Medicine who calls the issue a “looming catastrophe” says that annual costs are projected to climb to more than $40 billion by 2060, but that public health policy has been slow to address this issue partly because emergency general surgeries have been considered too difficult to characterize and measure. That’s because they encompass an almost infinitely diverse range of injuries, conditions and diseases bound together by only one thing: their urgent nature.

But in a paper published in JAMA Surgery on Wednesday, researchers found a surprising pattern. In an analysis of 421,476 patient records from a national database of hospital inpatients, they discovered that a mere seven procedures accounted for approximately 80 percent of all admissions, deaths, complications and inpatient costs related to emergency surgeries. The sample included only adults who underwent a procedure within two days of admission from 2008 to 2011.

The seven dangerous and costly procedures are mostly related to the organs of the digestive system: removing part of the colon, small-bowel resection, removing the gallbladder, operations related to peptic ulcer disease, removing abdominal adhesions, appendectomy and other operations to open the abdomen.

Joaquim M. Havens, a researcher at Brigham & Women’s Hospital in Boston, and colleagues said some limitations of the study include the fact that it was based on claims data, which sometimes have missing information and other issues, and that patients who did not undergo operations were excluded but might have provided valuable information about possible differences in care when it’s managed by surgeons and non-surgeons. Moreover, the analysis was limited to patients who had an operation within two days of being admitted, so it doesn’t account for the full burden of these kinds of procedures.

However, the authors suggested that there’s value in having quality benchmarks and cost-reduction strategies focus on these procedures.

“Given their high prevalence nationally and high proportion of burden they represent … the 7 procedures identified in this study could lead to better clinical decision making, patient outcomes, and cost savings,” they wrote.

Paul, who wrote a commentary on the JAMA Surgery study, said it “adds important information” to identify improving outcomes and reducing costs in the management of patients, and he suggests further study of these procedures should be done because “what is now a national burden will soon become a crisis.”

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