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The public health burden of emergency general surgery in the United States: A 10-year analysis of the Nationwide Inpatient Sample—2001 to 2010

Gale, Stephen C. MD; Shafi, Shahid MD, MPH; Dombrovskiy, Viktor Y. MD, MPH, PhD; Arumugam, Dena MD; Crystal, Jessica S. MD

Journal of Trauma and Acute Care Surgery: August 2014 - Volume 77 - Issue 2 - p 202–208
doi: 10.1097/TA.0000000000000362
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BACKGROUND Emergency general surgery (EGS) represents illnesses of very diverse pathology related only by their urgent nature. The growth of acute care surgery has emphasized this public health problem, yet the true “burden of disease” remains unknown. Building on efforts by the American Association for the Surgery of Trauma to standardize an EGS definition, we sought to describe the burden of disease for EGS in the United States. We hypothesize that EGS patients represent a large, diverse, and challenging cohort and that the burden is increasing.

METHODS The study population was selected from the Nationwide Inpatient Sample, 2001 to 2010, using the AAST EGS DRG International Classification of Diseases—9th Rev. codes, selecting all EGS patients 18 years or older with urgent/emergent admission status. Rates for operations, mortality, and sepsis were compiled along with hospital type, length of stay, insurance, and demographic data. The χ2 test, the t test, and the Cochran-Armitage trend test were used; p < 0.05 was significant.

RESULTS From 2001 to 2010, there were 27,668,807 EGS admissions, 7.1% of all hospitalizations. The population-adjusted case rate for 2010 was 1,290 admissions per 100,000 people (95% confidence interval, 1,288.9–1,291.8). The mean age was 58.7 years; most had comorbidities. A total of 7,979,578 patients (28.8%) required surgery. During 10 years, admissions increased by 27.5%; operations, by 32.3%; and sepsis cases, by 15% (p < 0.0001). Mortality and length of stay both decreased (p < 0.0001). Medicaid and uninsured rates increased by a combined 38.1% (p < 0.0001). Nearly 85% were treated in urban hospitals, and nearly 40% were treated in teaching hospitals; both increased over time (p < 0.0001).

CONCLUSION The EGS burden of disease is substantial and is increasing. The annual case rate (1,290 of 100,000) is higher than the sum of all new cancer diagnoses (all ages/types): 650 per 100,000 (95% confidence interval, 370.1–371.7), yet the public health implications remain largely unstudied. These data can be used to guide future research into improved access to care, resource allocation, and quality improvement efforts.

LEVEL OF EVIDENCE Epidemiologic study, level III.

Supplemental digital content is available in the text.

From the Department of Surgery (S.C.G.), Division of Trauma Services, East Texas Medical Center, Tyler, Texas; Department of Surgery (S.C.G., V.Y.D., D.A., J.S.C.), Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey; and Baylor Institute for Health Care Research and Improvement (S.S.), Dallas, Texas.

Submitted: April 14, 2014, Revised: May 6, 2014, Accepted: May 6, 2014.

This study was presented as a poster at the 27th Annual Scientific Assembly of the Eastern Association for the Surgery of Trauma, January 14–18, 2014, in Naples, Florida.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: Stephen C. Gale, MD, Department of Surgery, Division of Trauma Services, East Texas Medical Center, 1020 E. Idel St, Tyler, TX 75701; email:

© 2014 Lippincott Williams & Wilkins, Inc.