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State-Based Surgical Implications in the Treatment of Gunshot Wounds as a Result of Registered Firearm Possession Levels
Sophia Salingaros
*1, George S. Corpuz
1, ishani premaratne
3, Chunhui Wang
2, Yoshiko Toyoda
5, Paul Kurlansky
2, Christine H. Rohde
41Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, New York, NY; 2Center for Innovation and Outcomes Research, Department of Surgery, Columbia University Medical Center, New York, NY; 3Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, CA; 4Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Medical Center, New York, NY; 5Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, New York, NY
Background: Americans are 25-times more likely to die from gunshot wound (GSW)-related causes compared to any other developed county. GSW injuries pose an enormous economic burden on the healthcare system. Prior analyses found that reconstructive plastic and orthopedic surgeons bear the largest surgical burden - nearly $77 billion annually. In light of ongoing policy discourse and varied state-based gun legislation, we sought to understand the relationship between registered guns per state, GSW incidence, surgical burden, and mortality.
Methods: Twelve states were selected from the Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID). HCUP-SID was queried for GSW incidences, etiologies, and ICD-10 indexed surgical interventions for multiple surgical specialties including reconstructive (orthopedic and plastic) from 2016 to 2018. Number of registered firearms per state was sourced from the Bureau of Alcohol, Tobacco, Firearms, and Explosives. Linear regression statistical modeling was employed to determine correlations between registered guns and variables of interest, normalized to respective state populations.
Results: Increased number of registered guns normalized to state population was positively correlated with increased GSW mortality (p<0.05). A similar trend was found between number of guns and GSW injuries from self-harm and legal intervention etiologies (p<0.001), and with neurosurgical and head and neck procedures (p<0.05). Positive association between registered guns and reconstructive surgical burden (p=0.08) as well as unintentional GSW etiology (p=0.05) approached significance.
Conclusions: Our study is the first to correlate state-based differences in registered firearms, GSW etiological incidence, and surgical burden. Our data suggest that states with a higher concentration of guns experience higher GSW mortality (particularly self-harm and legal intervention categories). Our work contributes to ongoing discussions regarding the rising GSW surgical treatment costs, which have particular relevance to reconstructive surgeons.
Table 1. Linear Regression Model for Association with Registered Guns Normalized to State Populations, 2016 - 2018.
| Variable | P-Value |
| GSW Incidence | 0.179 |
| GSW Mortality | 0.002* |
| GSW Etiology |
| Assault | 0.6372 |
| Self-Harm | < 0.001* |
| Unintentional | 0.051 |
| Undetermined | 0.198 |
| Legal Intervention | < 0.001* |
| Procedures |
| Neurosurgical | 0.042* |
| Head and Neck | 0.013* |
| Thoracic | 0.138 |
| Cardiac | 0.652 |
| Vascular | 0.172 |
| Gastrointestinal | 0.978 |
| Genitourinary | 0.496 |
| Reconstructive | 0.081 |
A p-value < 0.05 was considered statistically significant. Significant results indicated by (*).
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