E. De Jager1, A. H. Haider1, T. Uribe-Leitz1, J. C. McCarty1, E. Goralnick1,2, G. Ortega1 1Brigham And Women’s Hospital,Center For Surgery And Public Health, Department Of Surgery, Harvard Medical School,Boston, MA, USA 2Brigham And Women’s Hospital,Department Of Emergency Medicine,Boston, MA, USA
Introduction:
The relationship between various United States (US) state firearm legislative policies and firearm injuries is a source of ongoing public controversy. Prior work has shown that state level legislation is associated with firearms pediatric injuries, suicides, non-fatal injury hospital discharge rates and mortality. The relationship, however, between these policies and the need for operative intervention for firearm victims is unknown. Our objective was to examine firearm related surgical volume between states with and without strict firearm legislation.
Methods:
States were dichotomized based on the strength of their firearm legislation policies using scores from the 2014 Brady Campaign State Scorecard (strict = state score >0) and the 2014 Gifford’s Law Center to Prevent Gun Violence scorecard (strict = state grade above F). We then extracted firearm inpatient data from the 2014 State Inpatient Database (SID) for 28 available states. States were classified into those with (13) and without (15) strict firearm legislation polices. The surgical volume per population was calculated using the mean grouped firearm surgical prevalence, using ICD-9-CM Ecodes and the 2014 state population according to the US Census Bureau. Negative binomial regression was used to calculate the incident rate ratio (IRR) for surgical volume between strict and non-strict states adjusted for age, race/ethnicity, insurance status, income, injury severity score and Charlson comorbidity index.
Results:
10,920 patients hospitalized with firearm related injuries were identified. Overall 65.6% (American n=7,161) of these patients underwent a surgical procedure. These firearm related injuries were further classified as assault (59.3%, n=4,249), unintentional (29.6%, n=2,122) and self-harm (7.8%, n=556). The mean age of the patients was 33 years (SD 13.9). Other patient demographics are shown in the table. The unadjusted rate of firearm surgical procedures per 100,000 people was higher in non-strict states 1.11 (95% CI, 1.01-1.20) compared to strict states 0.32 (95% CI, 0.27-0.37) (<0.001). The adjusted incidence rate of firearm related surgical procedures was 2.57 (95% CI; 2.25 -2.93, p<0.001) times higher in non-strict states compared to strict states.
Conclusion:
Residents in non-strict firearm legislation policy states were 2.57 times more likely to require a firearm related surgical intervention compared to states with strict firearm legislation policies. States could reevaluate their firearm legislation policies to reduce the burden of firearm surgical intervention.
