Reducing emergency surgery cuts health care costs

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.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."