As hospitals and health systems increasingly focus on addressing the rising cost of health care in the United States, and with the expense of surgical care playing a major role, physician researchers and others across the healthcare industry are working to identify innovative ways to reduce surgical costs.
In new findings published online in the journal Annals of Surgery on December 19, 2014, researchers determined the hospital costs and risk of death for emergency surgery and compared it to the same operation when performed in a planned, elective manner for three common surgical procedures: abdominal aortic aneurysm repair, coronary artery bypass graft and colon resection.
"If 10 percent of these emergency surgeries had been performed electively, the cost difference would have been nearly $1 billion over 10 years," said Adil Haider, MD, MPH, director of the Center for Surgery and Public Health at Brigham and Women's Hospital (BWH) and lead author of the paper. "Importantly, elective procedures are better for patients, too, who experience lower rates of mortality and better outcomes. There is a tremendous opportunity to both save lives and decrease costs."
Haider, who conducted this research while at the Center for Surgical Trials and Outcomes Research at Johns Hopkins, with colleagues from Howard University, analyzed data from a nationally representative sample of 621,925 patients from 2001 to 2010 who underwent abdominal aortic aneurysm repair, coronary artery bypass graft and colon resection. The hospital's cost to care for these patients was calculated with standardized information on inpatient cost and charge as reported by hospitals to the Center for Medicare and Medicaid.
When compared to elective surgery, emergency surgery was 30 percent more expensive for abdominal aortic aneurysm repair, 17 percent more expensive for coronary artery bypass graft and 53 percent more expensive for colon resection. Researchers also found that patients who underwent elective surgery had significantly lower rates of mortality compared to those who had emergency surgical procedures.
"The costs of surgical care represent nearly 30 percent of total healthcare expenditures and they are projected to total more than $900 billion by 2025, said Haider. "As we, collectively in the healthcare industry, work to systematically address the rising cost of healthcare, reducing emergency surgeries for common procedures provides a significant opportunity that must be seriously and thoughtfully considered. Strategically aligning primary care, screening programs and other interventions could be an impactful way to both improve outcomes and reduce costs."
###
This research was funded by the National Institutes of Health (NIGMS K23GM093112-01), and the American College of Surgeons C. James Carrico Fellowship for the study of Trauma and Critical Care.
Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. BWH has more than 3.5 million annual patient visits, is the largest birthing center in Massachusetts and employs nearly 15,000 people. The Brigham's medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in patient care, quality improvement and patient safety initiatives, and its dedication to research, innovation, community engagement and educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Brigham Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, more than 1,000 physician-investigators and renowned biomedical scientists and faculty supported by nearly $650 million in funding. For the last 25 years, BWH ranked second in research funding from the National Institutes of Health (NIH) among independent hospitals. BWH continually pushes the boundaries of medicine, including building on its legacy in transplantation by performing a partial face transplant in 2009 and the nation's first full face transplant in 2011. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information, resources and to follow us on social media, please visit BWH's online newsroom.
Journal
Annals of Surgery