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9.25.2017

Miller School Trauma Surgeons Are First to Report Hidden Public Costs of Firearm Injuries

A group of trauma surgeons at the University of Miami Miller School of Medicine, working with a newly released federal database detailing hospital readmissions, has uncovered an unexpectedly high taxpayer-borne financial burden stemming from firearm injuries.

Studying the statistics in the Agency for Healthcare Research and Quality’s Nationwide Readmissions Database (NRD), the researchers calculated that the cost to U.S. taxpayers is slightly more than half a billion dollars a year. Their findings were recently published online by the journal Annals of Surgery.

But how they arrived at that cost is the real story, says the journal article’s first author, Rishi Rattan, M.D.

“The NRD is new, and it initially only included reports for 2013 and 2014, so those two years were the statistical foundation for our analysis,” said Rattan. “During that time, 45,462 patients were admitted to hospitals across the U.S. for firearm injury at an admission cost of $1.45 billion, or $791 million per year. Of that total, $65.5 million was the cost of patients who needed to be hospitalized again. The most common reasons are infection and follow-up psychiatric treatment due to conditions such as anxiety and post-traumatic stress. The cost and details of their care were previously unknown.”

The high cost to taxpayers is based on both demographics and some interesting twists in the rehospitalization process, according to Rattan’s surgical colleague, Tanya L. Zakrison, M.D., M.H.Sc., M.P.H., who was the article’s senior author. Both are assistant professors in the DeWitt Daughtry Family Department of Surgery and surgeons at the Ryder Trauma Center at UM/Jackson Memorial Hospital,

“Approximately two-thirds of people nationally who get shot and are hospitalized are either uninsured or publicly insured, costing taxpayers $518.5 million yearly,” she said. “One in six of them will end up having additional treatment at a different hospital, and this is the first study to follow gunshot victims who were treated at multiple hospitals. Moreover, there is a common pattern of those who were uninsured and initially treated at a for-profit hospital being sent to another hospital for follow-up treatment. This is called ‘fragmentation of care.’ The outcomes for those patients are not as good, and the practice adds to the financial burden on the average taxpayer.”

The two surgeons and their Miller School co-authors — Joshua Parreco, M.D., surgical resident, Nicholas Namias, M.D., professor of surgery and chief of the Division of Trauma and Acute Care Surgery, Gerd D. Pust, M.D., assistant professor of surgery, and D. Dante Yeh, M.D., associate professor of surgery — were inspired to conduct their research based on what they see on the job every day. Zakrison and co-authors reported in an earlier study this year that the level of gun violence in Miami-Dade County is twice the national average, and Rattan says he has treated as many as 10 gunshot victims at Ryder in a single night.

“Patching up holes in people doesn’t seem like enough,” said Rattan. “As a group, we feel that surgeon-scientists should do more. The information from our study can help improve patient care, outcomes, policy and spending. We believe that this is a step in the right direction.”

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