Sanchez Ortiz, Alvaro
(2015)
Mortality and costs from acute care surgical emergencies.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
There are growing difficulties in caring for patients with acute surgical emergencies. In response, some trauma centers restructured their surgical services, integrating critical care and emergency surgery into their trauma programs. Few studies have examined these; however, evidence of their effectiveness is far from conclusive. This project proposed to evaluate trends of hospitalizations, deaths and costs associated with acute surgical emergencies (non-traumatic surgical emergencies and trauma) and to determine the effect of trauma centers on mortality in adult patients with non-traumatic surgical emergencies, using the Nationwide Impatient Sample databases from 2005-2010 and the American Hospital Association’s Annual Survey database from 2010.
The results from this project demonstrated that despite the significant increases in non-traumatic surgical emergencies and trauma related hospitalizations over time, overall mortality and costs are decreasing significantly, perhaps related to improvement in hospital management for these acute surgical emergencies. However, there were some demographic and regional variations. Overall, patients are old and are getting more comorbidities and uninsured over time. Among NTSEm, mortality is not decreasing significantly over time for all surgical conditions. For the injured patients, falls is becoming the leading mechanism of injury and penetrating trauma related mortality is increasing over time in the United States. Penetrating injuries in the South demonstrated a significant increase in related hospitalization. Finally, the results from these secondary data analyses do not support the hypothesis that the presence of a structured trauma centers account for differences in mortality for patients with non-traumatic surgical emergencies.
The variations observed may be related to geographical differences in acute care surgical coverage for these traumatic and non-traumatic conditions. In the past, the needs of the injured patient drove the development of the field of trauma surgery; therefore, there is a need to develop systematic approaches to fulfill the needs of patients with non-traumatic surgical emergencies. Regionalization of care, registries and severity scores will need to be created for these acute care surgical conditions, to study more in depth the quality of care and outcomes research, as acute care surgical models continue to expand across the United States.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
| Creators | Email | Pitt Username | ORCID  |
|---|
| Sanchez Ortiz, Alvaro | ais6@pitt.edu | AIS6 | |
|
| ETD Committee: |
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| Date: |
28 April 2015 |
| Date Type: |
Publication |
| Defense Date: |
16 March 2015 |
| Approval Date: |
28 April 2015 |
| Submission Date: |
26 April 2015 |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Number of Pages: |
107 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Medicine > Clinical and Translational Science |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
acute care surgery, non-traumatic surgical emergencies, traumatic injuries, trauma centers |
| Date Deposited: |
28 Apr 2015 11:53 |
| Last Modified: |
19 Dec 2016 14:42 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/25071 |
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