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Emergency general surgery: Definition and estimated burden of disease

Shafi, Shahid MD, MPH; Aboutanos, Michel B. MD; Agarwal, Suresh Jr. MD; Brown, Carlos V.R. MD; Crandall, Marie MD, MPH; Feliciano, David V. MD; Guillamondegui, Oscar MD, MPH; Haider, Adil MD, MPH; Inaba, Kenji MD; Osler, Turner M. MD; Ross, Steven MD; Rozycki, Grace S. MD, MBA; Tominaga, Gail T. MD

Journal of Trauma and Acute Care Surgery: April 2013 - Volume 74 - Issue 4 - p 1092–1097
doi: 10.1097/TA.0b013e31827e1bc7
Original Articles

BACKGROUND Acute care surgery encompasses trauma, surgical critical care, and emergency general surgery (EGS). While the first two components are well defined, the scope of EGS practice remains unclear. This article describes the work of the American Association for the Surgery of Trauma to define EGS.

METHODS A total of 621 unique International Classification of Diseases—9th Rev. (ICD-9) diagnosis codes were identified using billing data (calendar year 2011) from seven large academic medical centers that practice EGS. A modified Delphi methodology was used by the American Association for the Surgery of Trauma Committee on Severity Assessment and Patient Outcomes to review these codes and achieve consensus on the definition of primary EGS diagnosis codes. National Inpatient Sample data from 2009 were used to develop a national estimate of EGS burden of disease.

RESULTS Several unique ICD-9 codes were identified as primary EGS diagnoses. These encompass a wide spectrum of general surgery practice, including upper and lower gastrointestinal tract, hepatobiliary and pancreatic disease, soft tissue infections, and hernias. National Inpatient Sample estimates revealed over 4 million inpatient encounters nationally in 2009 for EGS diseases.

CONCLUSION This article provides the first list of ICD-9 diagnoses codes that define the scope of EGS based on current clinical practices. These findings have wide implications for EGS workforce training, access to care, and research.

From the Committee on Severity Assessment and Outcomes, American Association for the Surgery of Trauma, Chicago, Illinois.

Submitted: September 19, 2012, Revised: September 23, 2012, Accepted: September 28, 2012.

AAST Committee on Severity Assessment and Patient Outcomes members are as follows: Shahid Shafi, MD MPH, Baylor Health Care System, Dallas, Texas (chair); Michel B. Aboutanos, MD, Medical College of Virginia, Richmond, Virginia; Suresh Agarwal, Jr., MD, Boston University, Boston, Massachusetts; Carlos V. R. Brown, MD, University Medical Center Brackenridge, Austin, Texas; Marie Crandall, MD, MPH, Northwestern University, Chicago, Illinois; David V. Feliciano, MD, Atlanta Medical Center/Mercer University, Atlanta, Georgia; Oscar Guillamondegui, MD, MPH, Vanderbilt University, Nashville, Tennessee; Adil Haider, MD, MPH, Johns Hopkins University, Baltimore, Maryland; Kenji Inaba, MD, Los Angeles County Medical Center, Los Angeles, California; Turner M. Osler, MD, University of Vermont, Burlington, Vermont; Steven Ross, MD, Cooper Medical School of Rowan University, Camden, New Jersey; Grace S. Rozycki, MD, MBA, Emory University, Atlanta, Georgia; and Gail T. Tominaga, MD, Scripps Health, San Diego, California.

Address for reprints: Shahid Shafi, MD, MPH, Baylor Institute for Health Care Research and Improvement, 8080 Central Expressway, Suite 500, Dallas, TX 75206; email:

© 2013 Lippincott Williams & Wilkins, Inc.