Acute care surgery: impact on practice and economics of elective surgeons

J Am Coll Surg. 2012 Apr;214(4):531-5; discussion 536-8. doi: 10.1016/j.jamcollsurg.2011.12.045. Epub 2012 Mar 6.


Background: The creation of an acute care surgery service provides a rich operative experience for acute care surgeons. Elective surgeons typically have concerns about whether their practice volume will be restored with elective cases. Acute care surgery has financial implications for both groups. The aim of this project is to examine the impact in terms of work relative value units (wRVUs), collections, and cases in both groups with creation of an acute care surgery service at our institution.

Study design: Work RVUs, collections, and case volume were examined from departmental records for 2 groups before and after acute care surgery service creation. The service began on September 1, 2008. Before this time, emergency surgical consults went to the general surgeon on call. After this date, all emergency consults were seen by acute care surgeons.

Results: The number of operations performed by the acute care surgery group increased significantly when the mean of the 2 years after institution of acute care surgery were compared with the mean of the 2 years preceding the service creation (1,639 vs 790/year; p = 0.007). There was no change in total operations done by the elective surgery group (2,763 vs 2,496/year: p = 0.13). Elective caseload, however, did increase by 23% in the elective surgery group. In the acute care surgery group, wRVUs increased by 140% and elective surgery group wRVUs decreased by 8%. Collections increased in both groups (acute care surgery 129%, elective surgery 7%) and the combined collections of the groups increased by $2,138,00 in the year after service creation.

Conclusions: Acute care surgery service creation took emergency business from the elective surgery group, but this was almost immediately replaced with elective cases. This resulted in higher collections for both groups and a resultant significant increase in collections in aggregate.

Publication types

  • Evaluation Study

MeSH terms

  • Critical Care / economics
  • Critical Care / organization & administration*
  • Elective Surgical Procedures / economics
  • Elective Surgical Procedures / statistics & numerical data
  • Emergency Medicine / economics
  • Emergency Medicine / organization & administration
  • Emergency Service, Hospital / economics
  • Emergency Service, Hospital / organization & administration*
  • General Surgery / education
  • General Surgery / organization & administration
  • Hospital Charges
  • Humans
  • Insurance, Health, Reimbursement
  • North Carolina
  • Practice Patterns, Physicians'* / economics
  • Practice Patterns, Physicians'* / statistics & numerical data
  • Program Evaluation
  • Retrospective Studies
  • Specialties, Surgical / economics
  • Specialties, Surgical / organization & administration
  • Surgery Department, Hospital / economics
  • Surgery Department, Hospital / organization & administration*
  • Traumatology / economics
  • Traumatology / organization & administration
  • Workload / statistics & numerical data*