Cost Analysis of Nonoperative Management of Acute Appendicitis in Children

[dr.j.cardey@wanadoo.fr]

Cost Analysis of Nonoperative Management of Acute Appendicitis in Children
Journal of Pediatric Surgery
J Pediatr Surg 2017 Feb 04;[EPub Ahead of Print], M Mudri, K Coriolano, A Bütter

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•This retrospective study reviewed the cost-effectiveness of treating children with acute appendicitis non-operatively (n = 26) compared with laparoscopic appendectomy (n = 26). The non-operated group had significantly longer median total length of stay compared with the operated group, (34.5 h vs 17.5, respectively; P = .01). The median appendectomy cost was $1416.14. There was no significant difference in median total hospital costs between the two groups (operated, $3708.68; non-operated, $2698.99).

•Total treatment costs were similar for children with acute appendicitis treated non-operatively compared with laparoscopic appendectomy, possibly due to high failure rates in non-operated cases.

abstract
This abstract is available on the publisher’s site.

PURPOSE
The purpose of this study was to determine if nonoperative management of acute appendicitis in children is more cost effective than appendectomy.

METHODS
A retrospective review of children (6-17years) with acute appendicitis treated nonoperatively (NOM) from May 2012 to May 2015 was compared to similar patients treated with laparoscopic appendectomy (OM) (IRB#107535). Inclusion criteria included symptoms ≤48h, localized peritonitis, and ultrasound confirmation of acute appendicitis. Variables analyzed included failure rates, complications, length of stay (LOS), and cost analysis.

RESULTS

26 NOM patients (30% female, mean age 12) and 26 OM patients (73% female, mean age 11) had similar median initial LOS (24.5h (NOM) vs 16.5h (OM), p=0.076). Median total LOS was significantly longer in the NOM group (34.5h (NOM) vs 17.5 (OM), p=0.01). Median cost of appendectomy was $1416.14 (range $781.24-$2729.97). 9/26 (35%) NOM patients underwent appendectomy for recurrent appendicitis. 4/26 (15%) OM patients were readmitted (postoperative abscess (n=2), Clostridium difficile colitis (n=1), postoperative nausea/vomiting (n=1)). Median initial hospital admission costs were significantly higher in the OM group ($3502.70 (OM) vs $1870.37 (NOM), p=0.004)). However, median total hospital costs were similar for both groups ($3708.68 (OM) vs $2698.99 (NOM), p=0.065)).

CONCLUSION

Although initial costs were significantly less in children with acute appendicitis managed nonoperatively, total costs were similar for both groups. The high failure rate of nonoperative management in this series contributed to the total increased cost in the NOM group.

LEVEL OF EVIDENCE

3b.

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