National Trends and Cost Burden of Surgically Treated Gunshot Wounds in the US.

INTRODUCTION: Gun violence remains a major burden on the US healthcare system with annual costs exceeding $170 billion. Literature regarding the national trends in costs and survival of gun violence victims requiring operative interventions is lacking.

STUDY DESIGN: All adults admitted with a diagnosis of gunshot wound (GSW) requiring operative intervention(s) were identified using the 2005-16 National Inpatient Sample (NIS). The International Classification of Diseases Injury Severity score (ICISS), a validated prediction tool, was used to quantify the extent of traumatic injuries. Survey-weighted methodology was employed to provide national estimates. Hospitalizations exceeding the 66th percentile of annual costs were considered as high cost tertile (HCT). Multivariable logistic regressions with stepwise forward selection were used to identify factors associated with mortality and HCT.

RESULTS: Over the study period, 262,098 admissions met inclusion criteria with a significant increase in annual frequency and decrease in ICISS scores. A decline in mortality (8.6% to 7.6%, P-trend=0.03) was accompanied by increasing mean costs ($25,900 to $33,000, NP- trend<0.001). After adjusting for patient and hospital characteristics, head and neck (adjusted odds ratio (AOR): 31.2; 95% CI: 11.0-88.4, P<0.001), vascular operations (AOR: 24.5; 95% CI:19.2-31.1, P<0.001), and gastrointestinal (AOR: 27.8; 95% CI:17.2-44.8, P<0.001), were independently associated with HCT designation compared to patients who did not undergo these operations.

CONCLUSION: Over the past decade, the increase in gun violence and severity has resulted in higher costs. Operations involving selected surgical treatments incurred higher in-hospital costs. Given the profound economic and social impact of surgically treated GSWs, policy and public health efforts to reduce gun violence are imperative.