Surgical resource consumption in an academic health consortium

Health care costs continue to spiral; aggregate costs for 1992 are $850 billion, 13.6% of the U.S. gross national product. The issue has assumed national proportions, and change appears to be on the federal agenda. Great interest in surgical expenditures exists, which comprise 30.1% of all health care outlays.

We analyzed 13,600 general surgical patients in eight teaching hospitals in New Jersey during 1988. Hospital resource consumption was measured for hospital length of stay, hospital cost per patient, race, gender, diagnoses and procedures, and mortality rate.

Surgical patients at these medical centers had a mean hospital cost per patient of $8,193, mean hospital length of stay of 12.4 days, an emergency admission rate of 40.4%, and a mortality rate of 6.0%. Emergency admissions had higher costs compared with nonemergencies ($11,717 vs $5,804, p < 0.001) and a poorer outcome (11.2% mortality rate vs 2.6%, p < 0.01). Patients who died had a higher hospital cost per patient compared with survivors ($29,314 vs $6,837, p < 0.001) and a higher emergency admission rate (74.7% vs 38.2%, p < 0.001).

Changes to the surgical delivery system will occur during the next decade. This study showed factors associated with higher hospital costs for surgical patients; changing reimbursement systems must recognize these characteristics for surgical patients in teaching hospitals. Factors associated with emergency admission and mortality, once identified, could be used to improve the health delivery system that affects surgical patients.