title: An acute care surgery service generates a positive contribution margin in an appropriately staffed hospital.
abstract: BACKGROUND
  Acute care surgery (ACS) includes trauma, surgical critical care, and emergent general surgery. There is a national shortage of institutions that can provide for patients needing access to emergency surgical care. Inability to fund ACS surgeons can be a barrier. We hypothesize that an ACS service, in an appropriately staffed hospital, generates a positive contribution margin (CM).
  
  
  METHODS
  Fiscal data for 2009 were retrospectively reviewed at the University of Kentucky, a Level I trauma center with an ACS service. Contribution margin (ie, net revenue minus direct costs) and mean length of stay were calculated for all patients admitted to the ACS service. Inpatient data were stratified by trauma vs general surgery, emergent vs elective, and by payor mix.
  
  
  RESULTS
  Annual CM associated with the 5 ACS faculty was $21,799,000. Trauma generated higher CM than general surgery. General surgery had a greater CM, more if emergent than if elective ($9,500 vs $5,500; p < 0.01). Self-payment was lower with emergent general surgery vs trauma (20% vs 25%; p = 0.02).
  
  
  CONCLUSIONS
  Acute care surgery generates a positive CM. Emergent general surgery generates a greater CM than elective general surgery because of increased case mix index. These data suggest that hospital subsidization of acute care surgeons is financially feasible and might address the surgical workforce shortage and the critical problem of access to emergency surgical services.
authors.affiliation: Division of General Surgery, UK College of Medicine, University of Kentucky, Lexington, KY 40536-0298, USA. levidprocter@gmail.com
authors.forename: Levi
authors.initials: L
authors.lastname: Procter
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Bernard
authors.forename: Ryan L
authors.initials: RL
authors.lastname: Korosec
authors.forename: Paula L
authors.initials: PL
authors.lastname: Chipko
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kearney
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Zwischenberger
mesh_terms: D003365:Costs and Cost Analysis; D003422:Critical Care / Q000191:economics*; D003953:Diagnosis-Related Groups; D004636:Emergency Service, Hospital / Q000191:economics*; D004638:Emergency Treatment / Q000191:economics*; D006801:Humans; D007629:Kentucky; D007902:Length of Stay / Q000706:statistics & numerical data; D017146:Models, Organizational; D012189:Retrospective Studies; D013043:Specialties, Surgical / Q000191:economics*; D014193:Trauma Centers / Q000191:economics*; D000078329:Workforce