番茄社区

A single urban trauma center that treated nearly 1,000 gunshot victims over a more-than 2-year period spent an average of nearly $675,000 a month on their care, a new report finds.

Over a 27-month period ending in 2018, the total cost of patient treatment for gun-related injuries reached $18.1 million, reported Heather Vallier, MD, of MetroHealth Medical Center in Cleveland, and colleagues during a poster session at the American Academy of Orthopaedic Surgeons annual meeting.

Now, thanks to a pandemic-era jump in gun violence, the per-month cost is estimated to surpass $1 million. The hospital (MetroHealth), and taxpayers, will have to eat much of the cost as many of these patients are uninsured.

"We knew it would be a lot of money, but I thought we'd be spending less," Vallier, an orthopedic trauma surgeon, told 番茄社区. "It's a huge economic burden to the hospital system."

The researchers launched the study to better understand the costs of treating gunshot wounds. Other studies have examined the cost of gunshot wounds nationwide, but few if any have examined expenses at individual hospitals.

The researchers analyzed data on 941 gunshot victims who were treated at the level-one trauma center. Mean age was 30, 79% were male, and 85% were African American. Just over 80% were admitted and 8% died. Sixteen percent were frequent gunshot victims, with either previous or subsequent gunshot wounds.

Vallier's group estimated costs based on data from an earlier sample of gunshot patients and adjusted them for inflation up to 2018. Of the wounds, 37% were to the extremities (average cost $19,294), 23% were to the skin/subcutaneous tissue ($4,331), 7% to the abdomen ($58,749), 7% to the chest ($3,424), 6% to the head or neck ($68,528), and 20% to two or more body regions (average costs of $22,202 for two regions and $23,056 for three).

Why is the chest wound cost so low? "The number of those patients is pretty small, and the costs of care are much lower since they often don't require surgery and tend to have shorter hospital stays," Vallier said.

Other patients can be easily treated as well, such as those with superficial gunshot wounds who can be sent home with pain medication and bandages after a tetanus shot, Vallier said.

"Unfortunately, a lot of people get shot more than once and in very tenuous places such as around their chest and abdomen," she said. "Many need surgical care because of bleeding and broken bones that need to be stabilized. All of those things are very expensive."

The average cost for all gunshot wound patients amounted to $671,541 per month. One-third of the patients were uninsured and 55% were on Medicaid.

Vallier estimates that the monthly cost for gunshot wound care in the hospital is now perhaps close to $1.2 million due to an increase in violence since the pandemic started. "We used to see a few dozen new gunshot patients every month. It's probably been double or triple that during the pandemic," she said. "Last weekend, we had 13 patients."

Outside experts noted that the study doesn't tell the full story of the cost of gun violence.

"Not too much is a mystery about hospital costs," Thomas Weiser, MD, MPH, an associate professor of surgery at Stanford University School of Medicine in California, told 番茄社区. "What we do not know is costs outside the hospital -- rehab, home care, ongoing medication needs, etc. We really do not know much about long-term medical costs at all."

Joseph Sakran, MD, MPA, MPH, a trauma surgeon at Johns Hopkins Medicine in Baltimore, told 番茄社区 that the study is another indicator of the high cost of gun violence. However, he said, "as a single-center study, it is limited by the information available in the database, and only looked at hospital costs. I worry that this is a underestimate of the economic burden that we face as institutes and a nation."

Sakran is co-author of that estimated the average emergency department and inpatient charges for victims of gun violence from 2006-2014 as $5,254 and $95,887, respectively, translating to an annual cost of $2.8 billion nationwide. The Cleveland hospital's costs appear to be lower on average for reasons that are unclear, but Vallier said the difference may be related to the models used in the studies.

Sakran added that information about costs could sway people to care more about gun violence. "If you are not moved by the human toll that gun violence has on our society," he said, "I hope that the economic burden of this disease can allow us to realize the importance of addressing this public health crisis."

In Cleveland, MetroHealth Medical Center is working to provide extensive follow-up services after hospital treatment to help the gunshot patients "see a way out of their current lifestyle," Vallier said. Among other efforts, new gunshot victims hear from former trauma patients, including one who works as a "," a new kind of position.

"I don't think they know or realize their life can be different," she said. "But I believe we can fully chip away at this."

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