Nationwide comparison of the medical complexity of patients by surgical specialty

ObjectiveIntuitively, the chronic disease burden of surgical patients varies considerably by specialty, although sparse evidence in literature supports this notion. We sought to characterize medical complexity specialty and quantify association between outcomes.MethodsThe National Inpatient Sample, an all-payer inpatient database representative 97% all U.S. hospitalizations, was used identify adults undergoing surgery 2005 2014. The most commonly performed operations that constituted 80% each specialty's practice were abstracted. previously validated Elixhauser Comorbidity Index (ECI) calculated per year as a measure complexity. Outcomes resource utilization assessed comparing mortality rate, length stay, cost.ResultsAn estimated 53,232,144 underwent one nine categories. Surgical specialties ranked ECI, with cardiac (3.56), vascular (3.49), thoracic (2.86) having highest mean ECI (all P values <.0001 compared surgery). Whereas high scores driven arrhythmias hypertension, had more uniform distribution comorbidities. average for increased during study period from 2.03 2.65 2014 (P < .001), similar trend considered. Unlike two lowest comorbidities (orthopedic endocrine surgery), exhibited significantly higher mortality, LOS, costs.ConclusionsAlthough have increase past decade, candidates appear carry largest conditions. Despite caring emergent operations, did not costs, or stay some other specialties. intensity care assumed risk treating medically complex should be taken into consideration deciding health policy, reimbursement, hospital allocation.