The rise in firearm violence has coincided with an increase in the severity of injuries firearms inflict as well as the cost of operations.
«Taken together, our findings suggest that gun violence has increased in numbers, at least for the sector that meets surgical criteria, and that these injuries result in a substantial financial burden in addition to the obvious psychosocial burden and other downstream effects,» said lead study author Peyman Benharash, MD, MS, with the Cardiovascular Outcomes Research Laboratories and an associate professor-in-residence of surgery and bioengineering at the David Geffen School of Medicine at the University of California Los Angeles. «We hope that our findings are able to better inform policy in terms of violence prevention as well as reimbursement to hospitals, which are often in underserved regions, that care for these patients.»
The study authors note that gun violence overall carries an annual cost to the U.S. health care system of $170 billion, with $16 billion for operations alone. The researchers used the National Inpatient Sample (NIS) to identify all hospital admissions for gunshot wounds (GSW) from 2005 through 2016. The researchers did not look at all adult GSW victims admitted to the hospital, estimated at 322,599, but only at the 262,098 victims who required at least one major operation.
Dr. Benharash explained the rationale for the study. «We’re now seeing a lot more on the impact of gun violence,» he said. «In the past, gun violence was never really discussed in the open; it was thought to only affect a certain population. However, now we know that it affects everyone. In the hopes of trying to reduce it at a systemic level from top to bottom, we’re reporting, as surgeons, how gun violence in the patients that we treat has changed over the last decade.»
The costs for hospitalizations, measured as median costs adjusted for gross domestic product, increased more than 27 percent over the 12-year study period, from $15,100 to $19,200 (p<0.001). The amount of time these patients spent in the hospital -- a major cost driver -- also increased from an average of 7.1 days to 12.6 days (p<0.001). The percentage of fatalities declined, from 8.6 percent in 2005 to 7.6 percent in 2016, despite an annual increase in overall admissions for GSW-related operations, from 19,832 in 2005 to 23,480 in 2016. The severity of these injuries, based on billing codes, increased slightly over that period, with predicted survival decreasing from 81 to 79 percent (P<0.001). The authors used a non-parametric test for trends to judge the significance of temporal changes in their analysis.
The cost analysis categorized operations by type and three different cost ranges: low, medium and high, with average costs of $7,400, $17,200, and $58,800, respectively. «We found that compared with those who were not operated on, patients having head-neck, vascular, and gastrointestinal operations had increased odds of being in the high-cost tertile,» Dr. Benharash said. «Being in the Western United States was also a predictor [of being in the high-cost tertile], as was being of Black race and having insurance by Medicaid. So there are certainly disparities that are socioeconomic in origin as well.»
For example, the study found that while 3.4 percent of all patients had operations for head and neck injuries, these operations were disproportionately represented in the low- and high-cost ranges, accounting for only 0.81 percent of the former but 7.1 percent of the latter. «Gunshot wounds to the neck, for example, can be very costly because they can affect many delicate structures as compared with lower extremities, and these patients often require extensive hospitalization and a greater number of procedures» Dr. Benharash said.
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Materials provided by American College of Surgeons. Note: Content may be edited for style and length.