1. Research Day 2014 Russell Russo MD June 27th, 2014 Orthopaedic Department

2. Disclosure I do not have the following relationship with commercial interests. A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

3. The Educational and Financial Cost of Gun Violence on an Urban University Medical Center Russo R MD, Accardo S MD, Fury M MS, Krause P MD Study performed at ILH, New Orleans, LA - LSU-New Orleans Orthopaedic Department

4. Background: In 2009, according to the United Nations Office on Drugs and Crime, 67% of all homicides in the U.S. were conducted using a firearm. (1) Post-Katrina New Orleans is no exception with rising gun violence plaguing the city. Other cities, such as Flint and Detroit, Michigan are also plagued with rising gun violence as well. http://www.cdc.gov/nchs/fastats/homicide.htm

5. Background Although homicides are well studied, the non fatal gunshot effects are less examined. With the dramatic increase in survival of these patients, thanks to advances in trauma learned on the battlefields of Iraq and Afghanistan, many patients are surviving and its effects on the field of orthopedics is noticeable.

6. Background: The goal of this study is to determine the impact gunshot violence has on resident education at a Level 1 urban trauma center. The cost to education is not alone, the financial cost of gunshot violence to an urban trauma center will also be calculated. The hypothesis is that the payer mix of victims often puts an burden on the state and taxpayers.

7. Methods The Interim Louisiana Hospital Trauma Registry was queried for a variety of variables for all patients who presented with an acute gunshot wound between 1/1/2007 to 12/31/2013. Variables included: Age, sex, race, payer status, date of injury, disposition, diagnoses, procedures performed, Alcohol level, Positive toxicology tests, and days in the hospital

8. Methods For the financial costs, the central business office compiled the bills of the hospital encounters associated with the acute gunshot wound diagnoses pulled from the Trauma Registry data The LSUHSC ILH annual economic report is public domain and was examined via the LSU Health website.

9. Results (Volume of Gun Violence)

10. Results

14. (The Effect on Orthopedic Surgeons)

15. Results

18. (The Victims of Gunshot Violence)

19. Results

25. (The Financial Cost)

26. Results

28. Financial Expense over 7 Years Hospital Charges: +$141,995,682.01 Collections: --$30,922,953.69 ---------------------------------------- TOTAL LOSS: --$111,072,728.33

29. Conclusions The incidence of Acute gunshot wounds at an urban trauma center shows 15% require inpatient orthopedic surgery on initial admission, and 23% of the orthopedic census is made up of gunshot victims How this affects resident education and the breadth of cases will have to be examined in future studies.

30. Conclusions Acute Gunshot Wound treatment has a true effect on the financial viability of the state and healthcare.

31. Conclusions Given the payor mix of gunshot victims, the enormous cost on the state and thus taxpayer is growing. This remains a non-accidental, preventable problem that adds an tremendous amount to our out of control healthcare spending in this nation This report on New Orleans undoubtedly echoes the same problems in similar urban locations around the country.

32. Thank You