The impact of solid organ injury management on the US health care system

Abstract

Background: Since the 1980s, there has been a paradigm shift toward nonoperative management of stable patients with solid organ injury. The impact of this practice change on national health care expenditure has not been well characterized.

Methods: Hospital discharge data from the Healthcare Cost Utilization Project Nationwide Inpatient Sample from every other year spanning 1994 to 2010 were studied using patients with a primary diagnosis of splenic and liver injury. Cost analysis was performed using cost-to-charge ratios, where actual costs of hospitalization with current management practices were compared with theoretical costs projecting 1994 practice patterns. Length of stay (LOS) was evaluated similarly to costs. Mortality risk was established using the validated Trauma Mortality Prediction Model.

Results: Data from 29,409 adult patients with splenic injury and 14,704 with liver injury were used for cost and LOS analysis. The proportion of patients undergoing nonoperative management increased from 38% to 67% for splenic injury and from 62% to 81% for liver injury. The mean cost for splenic injury dropped by $8,421 per patient, a net reduction in total costs per admission of 29.5% (p < 0.0001), resulting in a mean estimated $12 million per year reduction in cost of care in 2008 alone. For liver injury, cost has been reduced by $8,822 per patient, a 27.7% reduction (p < 0.0001), with a net $17 million per year savings. LOS has been reduced by a mean ± SE of 1.9 ± 0.7 days per splenic injury (p = 0.0001) and 2.2 ± 0.9 days for liver injury (p = 0.0001). Mortality rate of high-risk patients (Trauma Mortality Prediction Model > 0.3) treated conservatively for splenic injury fell from 30% to 20% and from 64% to 18% for liver injury.

Conclusion: The trend toward nonoperative management of solid organ injury has resulted in a substantial decrease in health care expenditure and LOS while improving mortality for high-risk patients. Advances in trauma care can have significant impact on the cost of health care.

Level of evidence: Economic analysis, level III.