Costs of Care for Operative and Non-Operative Management of Emergency General Surgery Conditions

Abstract

Objective: Many emergency general surgery (EGS) conditions can be managed operatively or non-operatively, with outcomes that vary by diagnosis. We hypothesized that operative management would lead to higher in-hospital costs but to cost savings over time. Summary Background Data: Emergency general surgery conditions account for $28 billion in healthcare costs in the US annually. Compared to scheduled surgery, patients who undergo emergency surgery are at increased risk of complications, readmissions, and death, with accompanying costs of care that are up to 50% higher than elective surgery. Our prior work demonstrated that operative management had variable impacts on clinical outcomes depending on EGS condition. Methods: This was a nationwide, retrospective study using fee-for-service Medicare claims data. We included patients ≥ 65.5 years of age with a principal diagnosis for an EGS condition, 7/1/2015-6/30/2018. EGS conditions were categorized as: colorectal, general abdominal, hepatopancreaticobiliary, intestinal obstruction, and upper gastrointestinal. We used near-far matching with a preference-based instrumental variable to adjust for confounding and selection bias. Outcomes included Medicare payments for the index hospitalization and at 30, 90, and 180 days. Results: Of 507,677 patients, 30.6% received an operation. For hepatopancreaticobiliary conditions, costs for operative management were initially higher but became equivalent at 90 and 180 days. For all others, operative management was associated with higher inpatient costs which persisted, though narrowed, over time. Out-of-pocket costs were nearly equivalent for operative and non-operative management. Conclusions: Compared to non-operative management, costs were higher or equivalent for operative management of EGS conditions through 180 days, which could impact decision-making for clinicians, patients, and health systems in situations where clinical outcomes are similar.