Pediatric surgeons can lower health care costs if they remove a young patient's perforated appendix sooner rather than later, according to new study results published in the April issue of the Journal of the American College of Surgeons.
Acute appendicitis, which can precede a perforated appendix, disproportionately affects young people ages 10 to 19. However, the condition is more likely to progress to a perforation in children younger than age 4, according to previous research findings.1 It is estimated that approximately 77,000 children are hospitalized for appendicitis and similar conditions each year, and one-third of them will have a perforation before having an appendectomy, the operation performed to remove the appendix.1
The study authors found that hospital charges for children who had a perforated appendix removed 24 hours after diagnosis were about $10,000 lower than charges for children who had the surgical procedure six to eight weeks later, after first being treated for abdominal infections and contamination from the perforated appendix. Further, hospital costs for the patients who were treated early were approximately $5,000 lower than those who underwent
an appendectomy at a later time. One primary reason for the lower costs was that early appendectomy patients had better clinical outcomes and fewer adverse events.
Though both treatment approaches are common, "we hypothesized that the early surgical procedure would be better. In the trial, everyone is getting the same therapy - they're getting the appendix out. It's just a difference of when the operation happens," explained Martin L. Blakely, MD, FACS, study author and associate professor of surgery and pediatrics at Vanderbilt University School of Medicine, Nashville, Tenn. "Initially, we said that even if the clinical outcomes turned out to be the same, we need to know if costs are different."
Between October 2006 and August 2009, Dr. Blakely and fellow surgeons randomized 131 pediatric appendicitis patients at LeBonheur Children's Hospital, Memphis, Tenn., into two groups: One group was assigned to receive an early operation after diagnosis of perforated appendicitis, while the other would undergo the procedure up to eight weeks after diagnosis. The five participating surgeons performed the appendectomy according to the patient's randomization group. Each participating child's resource usage and cost data, including labor costs, supplies, facility services, and patient support services (ie: nutrition, social work, and family support) were then collected and analyzed. Analyses also included administrative and overhead costs, such as medical records management, information technology, admissions, and billing procedures.
Patients who underwent the later appendectomy (interval appendectomy) received more medical interventions than those who had the early appendectomy. Later appendectomy patients stayed in the hospital two days longer, and 87 percent received a central venous catheter, compared with only 44 percent of patients who had the early operation. Of all patients who received catheters, 43 percent of later appendectomy patients were discharged with it, compared with only 9 percent of early appendectomy patients.