Emergency General Surgery: Defining Burden of Disease in the State of Maryland

摘要

Acute care surgery services continue expanding to provide emergency general surgery (EGS) care. The aim of this study is to define the characteristics of the EGS population in Maryland. Retrospective review of the Health Services Cost Review Commission database from 2009 to 2013 was performed. American Association for the Surgery of Trauma-defined EGS ICD-9 codes were used to define the EGS population. Data collected included patient demographics, admission origin [emergency department (ED) versus non-ED], length of stay (LOS), mortality, and disposition. There were 3,157,646 encounters. In all, 817,942 (26%) were EGS encounters, with 76 per cent admitted via an ED. The median age of ED patients that died was 74 years versus 61 years for those that lived (P < 0.001). Twenty one per cent of ED admitted patients had a LOS > 7 days. Of 78,065 non-ED admitted patients, the median age of those that died was 68 years versus 59 years for those that lived (P < 0.001). Twenty eight per cent of non-ED admits had LOS > 7 days. In both ED and non-ED patients, there was a bimodal distribution of death, with most patients dying at LOS ￡ 2 or LOS > 7 days. In this study, EGS diagnoses are present in 26 per cent of inpatient encounters in Maryland. The EGS population is elderly with prolonged LOS and a bimodal distribution of death. Previous work has clearly shown the presence of an Acute Care Surgery service decreases patient-wait time for urgent emergency general surgery (EGS) procedures and improves outcomes in patients with common EGS pathologies. However, investigators have recently begun to describe what truly defines the EGS patient population and assess the true scope of disease. The true burden of EGS disease on the healthcare system and the interhospital transfer of patients, as it relates to outcomes, are not yet clearly defined. The aim of the current study is to better define the burden of EGS within the state of Maryland by using a unique statewide database that captures all patient-hospital encounters. We hypothesize that the burden of EGS disease within the state is significant and consists of an elderly population at higher risk of death than younger EGS patients.