• Adil H Haider, Augustine Obirieze, Catherine G Velopulos, Patrick Richard, Asad Latif, Valerie K Scott, Cheryl K Zogg, Elliott R Haut, David T Efron, Edward E Cornwell, Ellen J MacKenzie, and Darrell J Gaskin.
• *Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School & Harvard School of Public Health, Boston, MA †Department of Surgery, Howard University College of Medicine, Washington, DC ‡Center for Surgical Trials and Outcomes Research, The Johns Hopkins School of Medicine, Baltimore, MD §Department of Preventive Medicine & Biometrics (PMB), Uniformed Services University, Bethesda, MD ‖Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD **Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
• Ann. Surg. 2015 Aug 1; 262 (2): 260266260-6.

ObjectiveTo determine hospital costs and the adjusted risk of death associated with emergent versus elective surgery.BackgroundEmergency surgery has a higher cost and worse outcomes compared with elective surgery. However, no national estimates of the excess burden of emergency surgery exist.MethodsNationwide Inpatient Sample (NIS) data from 2001 to 2010 were analyzed. Patients aged 18 years or older who underwent abdominal aortic aneurysm repair, coronary artery bypass graft, or colon resection for neoplasm were included. Using generalized linear models with propensity scores, cost differences for emergent versus elective admission were calculated for each procedure. Multivariable logistic regression was performed to investigate the adjusted odds of mortality comparing elective and emergent cases. Discharge-level weights were applied to analyses.ResultsA total of 621,925 patients, representing a weighted population of 3,057,443, were included. The adjusted mean cost difference for emergent versus elective care was $8741.22 (30% increase) for abdominal aortic aneurysm repair, $5309.78 (17% increase) for coronary artery bypass graft, and $7813.53 (53% increase) for colon resection. If 10% of the weighted estimates of emergency procedures had been performed electively, the cost benefit would have been nearly $1 billion, at $996,169,160 (95% confidence interval [CI], $985,505,565-$1,006,834,104). Elective surgery patients had significantly lower adjusted odds of mortality for all procedures.ConclusionsEven a modest reduction in the proportion of emergent procedures for 3 conditions is estimated to save nearly $1 billion over 10 years. Preventing emergency surgery through improved care coordination and screening offers a tremendous opportunity to save lives and decrease costs.

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