The Unexpected Verdict: A Deep Dive into the Cost-Effectiveness of Emergency Surgery for Acute Gastrointestinal Conditions

In the field of emergency medicine, prompt and accurate decisions are pivotal in providing the best possible care for patients. But when it comes to acute gastrointestinal conditions, is emergency surgery the most cost-effective and clinically effective strategy? A recent study by Grieve et al. (2023) from the London School of Hygiene & Tropical Medicine sought to answer this question.

Objectives of the ESORT Study

The study set out to evaluate two key aspects: firstly, the clinical effectiveness of emergency surgery compared to non-emergency surgery strategies, and secondly, the cost-effectiveness of both approaches for five common acute gastrointestinal conditions presenting as emergency admissions. These conditions included acute appendicitis, cholelithiasis, diverticular disease, abdominal wall hernia, and intestinal obstruction.

Methodology: The Role of Clinical Coding

Using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis codes, the study analysed records of adults admitted as emergencies to 175 acute hospitals in England over nearly a decade. This is where the critical role of clinical coding comes into play: accurate diagnosis codes were essential in determining eligibility for the study. Emergency surgeries were identified using procedure codes from the Office of Population Censuses and Surveys.

Key Results: Not a One-Size-Fits-All Approach

The results were intriguing, showing that the average number of days alive and out of hospital at 90 days, costs, and quality-adjusted life-years were similar following either strategy. Notably, the cost-effectiveness varied significantly based on the patient’s fitness and frailty level.

For patients with severe frailty, non-emergency surgery was more cost-effective than emergency surgery. Conversely, for ‘fit’ patients, emergency surgery proved to be more cost-effective.

Clinical Coding: The Bridge to Better Healthcare Decisions

The importance of accurate clinical coding is clearly demonstrated in this study. By providing a detailed snapshot of a patient’s health status, clinical coders help inform the best course of treatment. This is particularly crucial in emergency situations, where quick and effective decisions can mean the difference between life and death.

Accurate clinical coding not only informs individual patient care but also enables larger studies like the ESORT study to assess the effectiveness and cost-effectiveness of different treatment strategies. The results of these studies can then guide healthcare policies and best practices.

The Takeaway: Informing Future Decisions about Surgery

The findings of the ESORT study highlight that neither emergency nor non-emergency surgery is a one-size-fits-all solution. The most cost-effective strategy may vary based on the individual patient’s health status.

This insight is critical for healthcare providers when making decisions about surgery for patients with acute gastrointestinal conditions. It also emphasises the need for personalised patient care, taking into account factors such as the patient’s fitness level and comorbidity profile.

Moreover, this study underscores the pivotal role of clinical coding in healthcare research, revealing how effective clinical coding can inform healthcare policies and improve patient care outcomes.


Grieve, R., Hutchings, A., Zapata, S. M., O’Neill, S., Lugo-Palacios, D. G., Silverwood, R., Cromwell, D., Kircheis, T., Silver, E., Snowdon, C., Charlton, P., Bellingan, G., Moonesinghe, R., Keele, L., Smart, N., & Hinchliffe, R. (2023). Clinical effectiveness and cost-effectiveness of emergency surgery for adult emergency hospital admissions with common acute gastrointestinal conditions: the ESORT study. Health and Social Care Delivery Research, 11(1). DOI: 10.3310/CZFL0619

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