The public health burden of emergency general surgery in the United States: A 10-year analysis of the Nationwide Inpatient Sample-2001 to 2010
The public health burden of emergency general surgery in the United States: A 10-year analysis of the Nationwide Inpatient Sample-2001 to 2010
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DOI：
10.1097/ta.0000000000000362
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发表时间：
2014-08-01
影响因子：
3.4
通讯作者：
Crystal, Jessica S.
中科院分区：
文献类型：
--
作者：
Gale, Stephen C.;Shafi, Shahid;Crystal, Jessica S.
背景：急诊普通外科（EGS）代表了非常多样化的病理学疾病，仅与其紧急性质相关。急性护理手术的增长强调了这一公共卫生问题，但真正的“疾病负担”仍然未知。基于美国创伤外科协会对EGS定义标准化的努力，我们试图描述美国EGS的疾病负担。我们假设，EGS患者代表一个大的，多样化的，具有挑战性的队列和负担increasing.METHODS：研究人群选自全国住院患者样本，2001年至2010年，使用AAST EGS DRG国际疾病分类-第9版代码，选择所有EGS患者18岁或以上的紧急/紧急入院状态。手术率、死亡率和脓毒症发生率与医院类型、住院时间、保险和人口统计学数据一起进行沿着。采用卡方检验、t检验和Cochran-Armitage趋势检验; p < 0.05具有显著性。结果：从2001年到2010年，有27，668，807例EGS住院，占所有住院的7.1%。2010年的人口调整病例率为每10万人1,290例（95%置信区间为1288.9 - 1291.8）。平均年龄为58.7岁;大多数有合并症。共有7，979，578例患者（28.8%）需要手术。在10年中，入院人数增加了27.5%，手术增加了32.3%，脓毒症病例增加了15%（p < 0.0001）。死亡率和住院时间均降低（p G 0.0001）。医疗补助和无保险的比率增加了38.1%（p < 0.0001）。近85%在城市医院接受治疗，近40%在教学医院接受治疗;两者均随时间增加（p < 0.0001）。年病例率（1，290/100，000）高于所有新癌症诊断的总和（所有年龄/类型）：650/100，000（95%置信区间，370.1-371.7），但公共卫生影响仍在很大程度上未得到研究。这些数据可用于指导未来的研究，以改善获得护理，资源分配和质量改进工作。版权所有（C）2014由Lippincott威廉姆斯& Wilkins
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 chi(2) 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 G 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. Copyright (C) 2014 by Lippincott Williams& Wilkins