Shabnam Hafiz1, Sameer Desale, Jack Sava. 1. From the Department of Surgery (S.H., J.S.), MedStar Washington Hospital Center, Washington, District of Columbia; and MedStar Health Research Institute (S.D.), Hyattsville, Maryland.
Abstract
BACKGROUND: Since the 1980s, there has been a paradigm shift toward nonoperative management of stable patients with solid organ injury. The impact of this practice change on national health care expenditure has not been well characterized. METHODS: Hospital discharge data from the Healthcare Cost Utilization Project Nationwide Inpatient Sample from every other year spanning 1994 to 2010 were studied using patients with a primary diagnosis of splenic and liver injury. Cost analysis was performed using cost-to-charge ratios, where actual costs of hospitalization with current management practices were compared with theoretical costs projecting 1994 practice patterns. Length of stay (LOS) was evaluated similarly to costs. Mortality risk was established using the validated Trauma Mortality Prediction Model. RESULTS: Data from 29,409 adult patients with splenic injury and 14,704 with liver injury were used for cost and LOS analysis. The proportion of patients undergoing nonoperative management increased from 38% to 67% for splenic injury and from 62% to 81% for liver injury. The mean cost for splenic injury dropped by $8,421 per patient, a net reduction in total costs per admission of 29.5% (p < 0.0001), resulting in a mean estimated $12 million per year reduction in cost of care in 2008 alone. For liver injury, cost has been reduced by $8,822 per patient, a 27.7% reduction (p < 0.0001), with a net $17 million per year savings. LOS has been reduced by a mean ± SE of 1.9 ± 0.7 days per splenic injury (p = 0.0001) and 2.2 ± 0.9 days for liver injury (p = 0.0001). Mortality rate of high-risk patients (Trauma Mortality Prediction Model > 0.3) treated conservatively for splenic injury fell from 30% to 20% and from 64% to 18% for liver injury. CONCLUSION: The trend toward nonoperative management of solid organ injury has resulted in a substantial decrease in health care expenditure and LOS while improving mortality for high-risk patients. Advances in trauma care can have significant impact on the cost of health care. LEVEL OF EVIDENCE: Economic analysis, level III.
BACKGROUND: Since the 1980s, there has been a paradigm shift toward nonoperative management of stable patients with solid organ injury. The impact of this practice change on national health care expenditure has not been well characterized. METHODS: Hospital discharge data from the Healthcare Cost Utilization Project Nationwide Inpatient Sample from every other year spanning 1994 to 2010 were studied using patients with a primary diagnosis of splenic and liver injury. Cost analysis was performed using cost-to-charge ratios, where actual costs of hospitalization with current management practices were compared with theoretical costs projecting 1994 practice patterns. Length of stay (LOS) was evaluated similarly to costs. Mortality risk was established using the validated Trauma Mortality Prediction Model. RESULTS: Data from 29,409 adult patients with splenic injury and 14,704 with liver injury were used for cost and LOS analysis. The proportion of patients undergoing nonoperative management increased from 38% to 67% for splenic injury and from 62% to 81% for liver injury. The mean cost for splenic injury dropped by $8,421 per patient, a net reduction in total costs per admission of 29.5% (p < 0.0001), resulting in a mean estimated $12 million per year reduction in cost of care in 2008 alone. For liver injury, cost has been reduced by $8,822 per patient, a 27.7% reduction (p < 0.0001), with a net $17 million per year savings. LOS has been reduced by a mean ± SE of 1.9 ± 0.7 days per splenic injury (p = 0.0001) and 2.2 ± 0.9 days for liver injury (p = 0.0001). Mortality rate of high-risk patients (Trauma Mortality Prediction Model > 0.3) treated conservatively for splenic injury fell from 30% to 20% and from 64% to 18% for liver injury. CONCLUSION: The trend toward nonoperative management of solid organ injury has resulted in a substantial decrease in health care expenditure and LOS while improving mortality for high-risk patients. Advances in trauma care can have significant impact on the cost of health care. LEVEL OF EVIDENCE: Economic analysis, level III.
Authors: Federico Coccolini; Giulia Montori; Fausto Catena; Yoram Kluger; Walter Biffl; Ernest E Moore; Viktor Reva; Camilla Bing; Miklosh Bala; Paola Fugazzola; Hany Bahouth; Ingo Marzi; George Velmahos; Rao Ivatury; Kjetil Soreide; Tal Horer; Richard Ten Broek; Bruno M Pereira; Gustavo P Fraga; Kenji Inaba; Joseph Kashuk; Neil Parry; Peter T Masiakos; Konstantinos S Mylonas; Andrew Kirkpatrick; Fikri Abu-Zidan; Carlos Augusto Gomes; Simone Vasilij Benatti; Noel Naidoo; Francesco Salvetti; Stefano Maccatrozzo; Vanni Agnoletti; Emiliano Gamberini; Leonardo Solaini; Antonio Costanzo; Andrea Celotti; Matteo Tomasoni; Vladimir Khokha; Catherine Arvieux; Lena Napolitano; Lauri Handolin; Michele Pisano; Stefano Magnone; David A Spain; Marc de Moya; Kimberly A Davis; Nicola De Angelis; Ari Leppaniemi; Paula Ferrada; Rifat Latifi; David Costa Navarro; Yashuiro Otomo; Raul Coimbra; Ronald V Maier; Frederick Moore; Sandro Rizoli; Boris Sakakushev; Joseph M Galante; Osvaldo Chiara; Stefania Cimbanassi; Alain Chichom Mefire; Dieter Weber; Marco Ceresoli; Andrew B Peitzman; Liban Wehlie; Massimo Sartelli; Salomone Di Saverio; Luca Ansaloni Journal: World J Emerg Surg Date: 2017-08-18 Impact factor: 5.469