Laparoscopic cholecystectomy performed within 2 days of presentation of acute cholecystitis yielded the best outcomes and lowest costs. Although causality could not be established, delaying LC was associated with more complications, higher mortality, and higher costs.

Even a modest reduction in the proportion of emergent procedures for 3 conditions is estimated to save nearly $1 billion over 10 years. Preventing emergency surgery through improved care coordination and screening offers a tremendous opportunity to save lives and decrease costs.

Sternal fractures occur infrequently with blunt force trauma. The demographics and epidemiology of associated injuries have not been well characterized from a national trauma database. The National Trauma Data Bank was queried for patients with closed sternal fractures. The demographics were analyzed by age, gender, mechanism and indicators of anatomic and physiologic injuries. Types of commonly associated injuries were also determined. A total of 23,985 records were analyzed. Males accounted for 68.3 per cent and whites 70.9 per cent. Motor vehicle crash was the leading mechanism. More than 56 per cent had severe injuries based on Injury Severity Score (greater than 15) and 17 per cent with Glasgow Coma Score 8 or less. Crude mortality was 7.9 per cent. The majority (57.8%) and approximately one-third (33.7%) of the patients had rib fractures and lung contusions, respectively, 22.0 per cent with closed pneumothorax, 21.6 per cent had a closed thoracic vertebra fracture, 16.9 per cent with lumbar spine fracture, 3.9 per cent with concussion, and blunt cardiac injury in 3.6 per cent. Sternal fractures are usually associated with severe blunt trauma. Lung contusion remains the leading associated injury followed by vertebral spine fractures. Cardiac injuries are less frequent and vascular injuries less so. Mechanism of injury and presence of sternal fractures should alert providers to these potential associated injuries.

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BACKGROUND Several studies have described the burden of trauma care but few have explored the economic burden of trauma inpatient costs from a payer’s perspective or highlighted differences in average costs per person by payer status. This study gives a conservative inpatient National trauma cost estimate, and describes variation in average inpatient trauma cost by payer status. METHODS A retrospective analysis of patients who received trauma care at hospitals in the Nationwide Inpatient Sample (NIS) for the years 2005–2010 was conducted. Our sample patients were selected using appropriate ICD-9-CM codes to identify admissions due to traumatic injury. Data were weighted to provide national population estimates and all cost and charges were converted to 2010 US Dollar equivalents. Generalized linear models were used to describe costs by payer status, adjusting for patient characteristics, such as age, sex, race, and hospital characteristics, such as location, teaching status and patient case mix. RESULTS A total of 2,542,551 patients were eligible for study, with payer status as follows: 672,960 (26.47%) patients with private insurance, 1,244,817 (48.96%) patients with Medicare, 262,256 (10.31%) with Medicaid, 195,056 (7.67%) of patients with self-pay, 18,506 (0.73%) with no charge, and 150,956 (5.94%) on other types of insurance. The estimated yearly trauma inpatient cost burden was highest for Medicare at $17,551,393,082(46.79%), followed by private insurance $10,772,025,421 (28.72%), Medicaid $3,711,686,012 (9.89%), self-pay $2,831,438,460 (7.55%), other payer types $2,370,187,494 (6.32%), and $274,598,190 (0.73%) for patients who were not charged for their inpatient trauma treatment. Our adjusted national inpatient trauma yearly costs were estimated at $37,511,328,659 US dollars. Privately insured patients had significantly higher mean cost than per person than Medicare, Medicaid, self-pay, or no charge patients. CONCLUSION This study demonstrates that the distribution of trauma burden across payers is significantly different from that of the overall healthcare system, and suggests that while the burden of trauma is high, the burden of self-pay/non-reimbursed inpatient services is actually lower than that of overall medical care. Level of Evidence: Prognostic study with Level II evidence