Emergency surgery costs disproportionately burden underrepresented racial and ethnic groups

A new nationwide study reveals that Black, Hispanic, and Asian/Pacific Islander patients face significantly higher costs when undergoing emergency surgeries compared to white patients, with the financial burden of unplanned procedures costing the health care system billions annually. The findings, published in Surgery Open Science, highlight how unequal access to preventive care translates into substantial financial and clinical disparities.

Health care spending in the United States is projected to consume nearly 20% of the nation’s entire economic output by 2028, making cost control a national priority. With over 45 million surgical procedures performed annually, even small improvements in surgical efficiency could generate massive savings.

Previous research suggested that converting just 10% of emergency surgeries to planned procedures for conditions covered by free screening under the Affordable Care Act could save $1 billion over a decade. However, known disparities in health care access mean these potential savings are not equally distributed.

Black patients receive significantly less screening for conditions like colorectal cancer, coronary artery disease, and abdominal aortic aneurysms, leading to more frequent emergency surgery. This creates a vicious cycle where those least able to afford health care face the highest costs, while the health care system misses opportunities for both better outcomes and substantial cost savings.

The study

Researchers analyzed data from over 3 million patients who underwent three major surgical procedures between 2011 and 2020 using the National Inpatient Sample, the largest publicly available all-payer health care database in the United States. They focused on abdominal aortic aneurysm repair, coronary artery bypass surgery, and colon cancer resection, procedures that are often performed electively when patients have access to regular screening and preventive care.

The team used advanced statistical models to compare hospitalization costs between emergency and planned surgeries across different racial groups, accounting for factors like age, insurance status, and underlying health conditions.

What they found

Emergency procedures cost an average of $13,645 more per patient than planned surgeries, a 33% increase in hospitalization costs. However, the financial penalty varied dramatically by race: Black patients faced an additional $15,552 in costs for emergency surgery (19% higher), Hispanic patients $14,525 (11% higher), and Asian/Pacific Islander patients $16,887 (29% higher), compared to $13,086 for white patients.

The proportion of emergency procedures also increased from 39.4% to 44.5% over the decade studied, adding to the overall cost burden. Emergency surgeries were also associated with higher rates of death, complications, and longer hospital stays. The researchers calculated that converting just 10% of emergency procedures to planned surgeries could save nearly $1.8 billion annually.

What’s next

The authors say the findings point to an urgent need for targeted interventions to improve access to preventive care and screening programs, particularly in Black, Hispanic, and Asian/Pacific Islander communities.

They suggest that health care systems should prioritize expanding community health programs, improving insurance coverage for preventive services, and addressing social determinants of health that contribute to delayed care. They note that policymakers may need to consider how current health care financing structures inadvertently penalize emergency care while potentially underinvesting in prevention.

The researchers recommend that future studies examine specific interventions that have successfully reduced emergency surgery rates and their cost-effectiveness across different populations.

From the experts

“These numbers reflect real individuals and families who face significant financial and health challenges due to unequal access to preventive care, a disparity that has previously been shown to be driven by racial inequities in health care,” said Dr. Saad Mallick, lead author of the study and a fellow at the Center for Advanced Surgical & Interventional Technology (CASIT) at the Department of Surgery at UCLA.

“What’s particularly striking is that these are largely preventable costs—we know how to screen for aneurysms, heart disease, and colorectal cancer. The question is whether we have the determination to ensure all Americans have equal access to these essential services.

“Every emergency surgery that could have been prevented underscores the potential to improve patient outcomes and the challenges they face, while also revealing a gap in the health care system.”