Nonfatal Firearm-Related Vascular Injuries: Clinical and Financial Implications in Trauma Care

Background: Gun violence is a growing public health crisis, with firearm-related vascular injuries leading to significant morbidity, mortality, and health care costs. Survivors of these injuries often experience severe complications, including limb loss, nerve damage, and prolonged hospital stays, contributing to long-term disability and economic burden. Vascular injuries, particularly those involving significant vessels such as the abdominal aorta, inferior vena cava, and femoral arteries, require complex surgical interventions and extensive postoperative care. These cases are associated with increased resource utilization, including longer intensive care unit stays, multiple operations, and higher hospital readmission rates. This study examines the cost, length of stay, and surgical burden associated with nonfatal firearm injuries (NFIs) involving vascular trauma. Given the growing interest in endovascular techniques as a less invasive alternative to open surgery, we also explore their potential role in reducing complications and costs. Understanding the financial and clinical impact of vascular firearm-related injuries is essential for optimizing treatment strategies and reducing the burden on both patients and health care systems. Methods: A single-center retrospective trauma registry was reviewed at a level-one academic trauma center between 2019 and 2021. The inclusion criteria were all patients with NFI. IBM SPSS (version 29.0) was used for descriptive analysis and independent samples T-tests. Further descriptive analysis was performed on patients suffering vascular injuries caused by NFI. Results: Of all 359 patients in the study, 104 (29%) suffered vascular injury. Of these patients, the mean age was 32 years (standard deviation 12.4), with 87.5% (n = 91) males and 12.5% (n = 13) females. Black race was the most common at 79.8% (n = 83), White race at 17.3% (n = 18), and multiracial at 2.9% (n = 3). Of the 77 patients for which the intention was known, 68.8% (n = 53) of the injuries were due to assault, 6.5% (n = 5) accidental self-harm, 9.1% (n = 7) intentional self-harm, 14.3% (n = 11) unintentional, and 1.3% (n = 1) from law enforcement. The mean total cost of stay for vascular injuries was significantly higher than injuries without vascular involvement ($49,050 vs. $31,763, P = 0.006). The mean length of stay was increased considerably at 10.88 days (vs. 7.68, P = 0.012), and the total number of trips to the operating room was also significantly increased at 2.53 (vs. 1.61, P = 0.013). Although nonsignificant, these patients attended a mean of 3.86 follow-up appointments compared to 2.94 appointments for nonvascular injury patients (P = 0.056). Conclusion: Given the high resource utilization associated with vascular injuries, optimizing trauma management is essential. Traditional open surgical repair remains the standard of care; however, emerging evidence suggests that endovascular techniques may provide a less invasive, cost-effective alternative with reduced complications and hospital stays. Hybrid operating rooms, which integrate advanced imaging and surgical capabilities, offer additional potential benefits in improving patient outcomes and reducing health care costs, although financial barriers to implementation remain. This study highlights the substantial burden of vascular firearm injuries on both patients and health care systems. The findings support the need for continued research into cost-effective, outcome-driven trauma care strategies, particularly exploring the role of endovascular interventions in improving survival and recovery.