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PURPOSE: Gunshot wound (GSW) injuries are estimated to cost as much as 126 billion to the healthcare system annually. Given the wide variety in state-based approaches to gun safety laws, we sought to evaluate the incidence of surgical GSW injuries with an emphasis on surgical subspecialties. METHODS: Thirteen states were chosen based on available data using the Healthcare Cost and Utilization Project — State Inpatient Database (HCUP-SID) from 2016 to 2018 and stratified by their gun law strength ranking as validated by the Giffords Law Center. HCUP-SID was queried for GSW injuries and surgical procedures using ICD-10 codes for the following specialties: neurosurgery, head and neck surgery, thoracic surgery, cardiac surgery, vascular surgery, gastrointestinal surgery, genitourinary surgery, and reconstructive surgery. A Cochran-Armitage statistical model was used to determine correlations between number of procedures performed and state gun law strength. RESULTS: Irrespective of gun law strength, reconstructive surgical procedures (orthopedic and plastic surgery) encompassed a large (often the largest) percentage of GSW-caused surgical interventions, ranging from 32. 4-53. 9%. There was a correlation between stronger gun law strength and fewer reconstructive surgical procedures performed (p<0. 0001). CONCLUSION: We use a state-based approach to understand the surgical burden of GSW injuries and how this differs between states. Regardless of gun law strength, reconstructive orthopedic and plastic surgery remain the most implicated of surgical specialties. Therefore, plastic surgeons should have a vested interest in the policy work being done to decrease the overall incidence of GSW injuries.
Corpuz et al. (Wed,) studied this question.