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Introduction: Payment structured around Episodes of Care is a method for incentivizing decreased care utilization after major procedures. We examined Major Bowel Episodes of Care (MB-EoC)-the focus among general surgery procedures-within a large health system to determine the contribution of emergency bowel surgery to higher costs of care., Methods: Adult MB-EoC cases from July 2018 to June 2021 were reviewed for 90-d costs, examining patient age, insurance, diagnosis, cost of care, and contributors to cost. For patients aged ≥45 y who had nonelective care for colon cancer, incidence of prior screening colonoscopy was examined., Results: We identified 1292 colectomy cases. Mean age was 65 y. Of these patients, 90% had Medicare/commercial insurance. Colon cancer comprised 41% of primary diagnoses. Twenty-eight percent of cases were nonelective, more likely to have Medicaid/underinsured (21% versus 7%, P < 0.001), and had higher utilization of postdischarge cost-drivers. Ninety-day EoC per case cost was 66% higher for emergent versus elective cases. Of eligible emergency cancer cases, 43% (40/93) had undergone prior colonoscopy within 10 y. For patients with colon cancer, 90-d EoC per case was 39% higher for emergent versus elective cases., Conclusions: Emergency MB-EoC cases disproportionally contribute to higher 90-d care utilization and costs. Efforts to increase screening colonoscopy in appropriate populations may have a substantial impact on MB-EoC costs., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Emergency general surgery (EGS) admissions account for more than three million hospitalizations in the US annually; and interhospital transfers (IHTs) are costly. We aimed to better understand the population of transferred EGS patients and their subsequent care in a nationally representative sample., Methods: Using the 2002-2011 Nationwide Inpatient Sample, we identified patients aged ≥18 years with an EGS noncardiovascular principal diagnosis who were transferred from another hospital with urgent or emergent admission status. Patient demographics, hospitalization characteristics, rates of operation, and mortality were identified. Procedure codes were classified into surgery and procedures based on the HCUP Surgery Flag., Results: We identified an estimated 525,913 EGS admissions transferred from another acute care hospital. The mean age was 60 years, 51% were female, and >50% were Medicare patients. The rate of EGS IHTs increased while mortality decreased. Surgery was required for only 33% of transferred patients. The most common surgeries were laparoscopic cholecystectomy, lysis of adhesions, and wound debridement. The median length of stay was 4.4 days, 92% of patients were cared for in urban hospitals, and >50% in teaching hospitals., Conclusions: The percent of patients with an EGS diagnosis requiring IHT is increasing, which may reflect a trend toward regionalization of EGS. Transfers require significant resources and may delay care. More than half of the EGS patients did not require surgical intervention. Future studies to identify populations who benefit from IHT and ideal timing of transfer can establish opportunities for optimizing resource utilization and patient outcomes., (Copyright © 2017 Elsevier Inc. All rights reserved.)