ATTENTION NEEDED Mortality rates ranged from 0.08% for appendectomies to 23.8% for laparotomies.

Seven procedures collectively account for 80% of emergency surgeries, deaths, complications and costs related to emergency surgeries in the United States, a new study published in JAMA Surgery finds.

The 7 — partial colectomy, small-bowel resection, cholecystectomy, operative management of peptic ulcer disease, lysis of peritoneal adhesions, appendectomy and laparotomy — represent a cross-section of surgeries that are either extremely common (appendectomy and cholecystectomy, for example) and/or that have relatively high mortality rates (laparotomy and management of peptic ulcer).

The study was based on more than 400,000 cases between 2008 and 2011. Mortality rates ranged from 0.08% for appendectomies to 23.8% for laparotomies. So while the mortality rate for appendectomies (about 1 of every 1,250 patients) is extremely low compared with most other emergency procedures, its high incidence boosts its importance. In contrast, laparotomies are performed only about 1.4% as often as appendectomies, but have a mortality rate approximately 300 times higher.

Complication rates ranged from 7.3% for appendectomies to 46.9% for small-bowel resections; and mean inpatient costs ranged from $9664.30 for appendectomies to $28,450.72 for small-bowel resections.

The 7 surgeries warrant special attention when it comes to establishing quality standards and reducing costs, say the authors. "National quality benchmarks and cost-reduction efforts should focus on these common, complicated and costly procedures," the authors conclude.

Jim Burger