Global surgical package reimbursement and the acute care surgeon: A threat to optimal care

Eric B. Schneider, Adil H. Haider, Anne O. Lidor, Jonathan Efron, Cassandra V. Villegas, Kent A Stevens, Salman A. Hirani, Elliott Haut, David Thomas Efron

Research output: Contribution to journalArticle

Abstract

Background: Emergency surgery patients risk greater mortality and morbidity than elective patients undergoing the same procedure. However, the differential effort required for the care of emergency surgical patients is poorly defined. This study sought to characterize costs and outcomes of elective versus emergent right hemicolectomy. Methods: 2006 Nationwide Inpatient Sample data were used to compare mortality, total charges, and length of stay (LOS) in patients undergoing emergency versus elective right hemicolectomy (International Classification of Diseases-9th procedure code 45.73). Mann-Whitney tests examined total costs and LOS; multivariable regression modeled inhospital mortality controlling for age, gender, insurance status, and comorbidities. Results: Among 8,074,825 inpatient admissions, 7,767 emergent and 10,399 elective right hemicolectomies were identified. Emergent patients were similar in age (66.9 years vs. 67.6 years; p = 0.129), more likely women (43.7% vs. 42.3%; p = 0.048) and had greater comorbidity (Charlson score 3.37 vs. 3.01; p <0.001) compared with elective patients. Emergent patient LOS was approximately double that of elective patients (13 days vs. 7 days; p <0.001). Mean total charges were $78,118 for emergent versus $39,265 elective patients (p <0.001). Emergent patients had greater odds of inhospital mortality (odds ratio, 5.86; 95% confidence intervals, 4.80-7.14). Conclusions: Emergent right hemicolectomy patients have greater comorbidity, experience longer stays, accrue twice the charges, and have higher mortality risk. This reflects a heightened effort required to care for emergent patients unrecognized by Global Surgical Package reimbursement. The concentration of emergency surgical patients in acute care surgery services necessitates accounting for the additional effort associated with these predictable risks to ensure optimal care.

Original languageEnglish (US)
Pages (from-to)583-589
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume70
Issue number3
DOIs
StatePublished - Mar 2011

Fingerprint

Comorbidity
Length of Stay
Emergencies
Hospital Mortality
Mortality
Inpatients
Surgeons
Costs and Cost Analysis
Insurance Coverage
Patient Rights
Emergency Medical Services
International Classification of Diseases
Patient Care
Odds Ratio
Confidence Intervals
Morbidity

Keywords

  • Acute care surgery
  • Global Surgical Package
  • Reimbursement

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Global surgical package reimbursement and the acute care surgeon : A threat to optimal care. / Schneider, Eric B.; Haider, Adil H.; Lidor, Anne O.; Efron, Jonathan; Villegas, Cassandra V.; Stevens, Kent A; Hirani, Salman A.; Haut, Elliott; Efron, David Thomas.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 70, No. 3, 03.2011, p. 583-589.

Research output: Contribution to journalArticle

@article{a754b7a6509b45c199529fefc8e4a25a,
title = "Global surgical package reimbursement and the acute care surgeon: A threat to optimal care",
abstract = "Background: Emergency surgery patients risk greater mortality and morbidity than elective patients undergoing the same procedure. However, the differential effort required for the care of emergency surgical patients is poorly defined. This study sought to characterize costs and outcomes of elective versus emergent right hemicolectomy. Methods: 2006 Nationwide Inpatient Sample data were used to compare mortality, total charges, and length of stay (LOS) in patients undergoing emergency versus elective right hemicolectomy (International Classification of Diseases-9th procedure code 45.73). Mann-Whitney tests examined total costs and LOS; multivariable regression modeled inhospital mortality controlling for age, gender, insurance status, and comorbidities. Results: Among 8,074,825 inpatient admissions, 7,767 emergent and 10,399 elective right hemicolectomies were identified. Emergent patients were similar in age (66.9 years vs. 67.6 years; p = 0.129), more likely women (43.7{\%} vs. 42.3{\%}; p = 0.048) and had greater comorbidity (Charlson score 3.37 vs. 3.01; p <0.001) compared with elective patients. Emergent patient LOS was approximately double that of elective patients (13 days vs. 7 days; p <0.001). Mean total charges were $78,118 for emergent versus $39,265 elective patients (p <0.001). Emergent patients had greater odds of inhospital mortality (odds ratio, 5.86; 95{\%} confidence intervals, 4.80-7.14). Conclusions: Emergent right hemicolectomy patients have greater comorbidity, experience longer stays, accrue twice the charges, and have higher mortality risk. This reflects a heightened effort required to care for emergent patients unrecognized by Global Surgical Package reimbursement. The concentration of emergency surgical patients in acute care surgery services necessitates accounting for the additional effort associated with these predictable risks to ensure optimal care.",
keywords = "Acute care surgery, Global Surgical Package, Reimbursement",
author = "Schneider, {Eric B.} and Haider, {Adil H.} and Lidor, {Anne O.} and Jonathan Efron and Villegas, {Cassandra V.} and Stevens, {Kent A} and Hirani, {Salman A.} and Elliott Haut and Efron, {David Thomas}",
year = "2011",
month = "3",
doi = "10.1097/TA.0b013e3182098a30",
language = "English (US)",
volume = "70",
pages = "583--589",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Global surgical package reimbursement and the acute care surgeon

T2 - A threat to optimal care

AU - Schneider, Eric B.

AU - Haider, Adil H.

AU - Lidor, Anne O.

AU - Efron, Jonathan

AU - Villegas, Cassandra V.

AU - Stevens, Kent A

AU - Hirani, Salman A.

AU - Haut, Elliott

AU - Efron, David Thomas

PY - 2011/3

Y1 - 2011/3

N2 - Background: Emergency surgery patients risk greater mortality and morbidity than elective patients undergoing the same procedure. However, the differential effort required for the care of emergency surgical patients is poorly defined. This study sought to characterize costs and outcomes of elective versus emergent right hemicolectomy. Methods: 2006 Nationwide Inpatient Sample data were used to compare mortality, total charges, and length of stay (LOS) in patients undergoing emergency versus elective right hemicolectomy (International Classification of Diseases-9th procedure code 45.73). Mann-Whitney tests examined total costs and LOS; multivariable regression modeled inhospital mortality controlling for age, gender, insurance status, and comorbidities. Results: Among 8,074,825 inpatient admissions, 7,767 emergent and 10,399 elective right hemicolectomies were identified. Emergent patients were similar in age (66.9 years vs. 67.6 years; p = 0.129), more likely women (43.7% vs. 42.3%; p = 0.048) and had greater comorbidity (Charlson score 3.37 vs. 3.01; p <0.001) compared with elective patients. Emergent patient LOS was approximately double that of elective patients (13 days vs. 7 days; p <0.001). Mean total charges were $78,118 for emergent versus $39,265 elective patients (p <0.001). Emergent patients had greater odds of inhospital mortality (odds ratio, 5.86; 95% confidence intervals, 4.80-7.14). Conclusions: Emergent right hemicolectomy patients have greater comorbidity, experience longer stays, accrue twice the charges, and have higher mortality risk. This reflects a heightened effort required to care for emergent patients unrecognized by Global Surgical Package reimbursement. The concentration of emergency surgical patients in acute care surgery services necessitates accounting for the additional effort associated with these predictable risks to ensure optimal care.

AB - Background: Emergency surgery patients risk greater mortality and morbidity than elective patients undergoing the same procedure. However, the differential effort required for the care of emergency surgical patients is poorly defined. This study sought to characterize costs and outcomes of elective versus emergent right hemicolectomy. Methods: 2006 Nationwide Inpatient Sample data were used to compare mortality, total charges, and length of stay (LOS) in patients undergoing emergency versus elective right hemicolectomy (International Classification of Diseases-9th procedure code 45.73). Mann-Whitney tests examined total costs and LOS; multivariable regression modeled inhospital mortality controlling for age, gender, insurance status, and comorbidities. Results: Among 8,074,825 inpatient admissions, 7,767 emergent and 10,399 elective right hemicolectomies were identified. Emergent patients were similar in age (66.9 years vs. 67.6 years; p = 0.129), more likely women (43.7% vs. 42.3%; p = 0.048) and had greater comorbidity (Charlson score 3.37 vs. 3.01; p <0.001) compared with elective patients. Emergent patient LOS was approximately double that of elective patients (13 days vs. 7 days; p <0.001). Mean total charges were $78,118 for emergent versus $39,265 elective patients (p <0.001). Emergent patients had greater odds of inhospital mortality (odds ratio, 5.86; 95% confidence intervals, 4.80-7.14). Conclusions: Emergent right hemicolectomy patients have greater comorbidity, experience longer stays, accrue twice the charges, and have higher mortality risk. This reflects a heightened effort required to care for emergent patients unrecognized by Global Surgical Package reimbursement. The concentration of emergency surgical patients in acute care surgery services necessitates accounting for the additional effort associated with these predictable risks to ensure optimal care.

KW - Acute care surgery

KW - Global Surgical Package

KW - Reimbursement

UR - http://www.scopus.com/inward/record.url?scp=79952808432&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79952808432&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e3182098a30

DO - 10.1097/TA.0b013e3182098a30

M3 - Article

C2 - 21610346

AN - SCOPUS:79952808432

VL - 70

SP - 583

EP - 589

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 3

ER -