title: Cognitive trauma care is undervalued: adult splenic injury as a paradigm.
abstract: Nonoperative management (NOM) of adult splenic injury is evolving. Economic aspects of NOM have not been examined. We hypothesize that NOM reduces hospital and professional charges. Surgeon, radiologist, and hospital charges and reimbursements, and clinical outcome were obtained for 77 consecutive adult splenic injury patients (> or = 15 years old) over a 3-year period. NOM succeeded in 30 of 31 patients. NOM was associated with lower surgeon fee ($1,148 vs $4,452; P < 0.0001), surgeon reimbursement ($587 vs $2,773; P = 0.0001), and hospital charge ($18,982 vs $48,790; P = 0.001) relative to operative management. Radiologist fee ($1,776 vs $2,285) and reimbursement ($1,069 vs $1,537) were not significantly affected. No significant difference existed between surgeon (primary care provider) and radiologist reimbursement for NOM. ISS poorly correlated with economic variables. We conclude that cost reductions are another potential advantage of NOM. Surgeon reimbursement for the cognitive skills involved in NOM is minimal. Future health finance policy should recognize the cognitive aspects of trauma care.
authors.affiliation: Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Sutyak
authors.forename: L F
authors.initials: LF
authors.lastname: D'Amelio
authors.forename: W C
authors.initials: WC
authors.lastname: Chiu
authors.forename: J S
authors.initials: JS
authors.lastname: Hammond
mesh_terms: D000293:Adolescent; D000328:Adult; D002983:Clinical Competence; D003363:Cost Control; D003422:Critical Care; D003657:Decision Making; D005251:Fees, Medical; D005260:Female; D013502:General Surgery; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration; D011320:Primary Health Care / Q000191:economics; D011871:Radiology / Q000191:economics; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013156:Splenectomy / Q000191:economics; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy