The economic footprint of acute care surgery in the United States: Implications for systems development

Lisa M. Knowlton, Joseph Minei, Lakshika Tennakoon, Kimberly A. Davis, Jay Doucet, Andrew Bernard, Adil Haider, L. R.Tres Scherer, David A. Spain, Kristan L. Staudenmayer

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


BACKGROUND Acute care surgery (ACS) comprises trauma, surgical critical care, and emergency general surgery (EGS), encompassing both operative and nonoperative conditions. While the burden of EGS and trauma has been separately considered, the global footprint of ACS has not been fully characterized. We sought to characterize the costs and scope of influence of ACS-related conditions. We hypothesized that ACS patients comprise a substantial portion of the US inpatient population. We further hypothesized that ACS patients differ from other surgical and non-surgical patients across patient characteristics. METHODS We queried the National Inpatient Sample 2014, a nationally representative database for inpatient hospitalizations. To capture all adult ACS patients, we included adult admissions with any International Classification of Diseases-9th Rev.-Clinical Modification diagnosis of trauma or an International Classification of Diseases-9th Rev.-Clinical Modification diagnosis for one of the 16 AAST-defined EGS conditions. Weighted patient data were presented to provide national estimates. RESULTS Of the 29.2 million adult patients admitted to US hospitals, approximately 5.9 million (20%) patients had an ACS diagnosis. ACS patients accounted for US $85.8 billion, or 25% of total US inpatient costs (US $341 billion). When comparing ACS to non-ACS inpatient populations, ACS patients had higher rates of health care utilization with longer lengths of stay (5.9 days vs. 4.5 days, p < 0.001), and higher mean costs (US $14,466 vs. US $10,951, p < 0.001. Of all inpatients undergoing an operative procedure, 27% were patients with an ACS diagnosis. Overall, 3,186 (70%) of US hospitals cared for both trauma and EGS patients. CONCLUSION Acute care surgery patients comprise 20% of the inpatient population, but 25% of total inpatient costs in the United States. In addition to being costly, they overall have higher health care utilization and worse outcomes. This suggests that there is an opportunity to improve clinical trajectory for ACS patients that in turn, can affect the overall US health care costs. LEVEL OF EVIDENCE Epidemiologic, level III.

Original languageEnglish
Pages (from-to)609-614
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Issue number4
StatePublished - Apr 1 2019

Bibliographical note

Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.


  • Acute care surgery
  • emergency general surgery
  • health care utilization
  • trauma
  • trauma systems

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


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