Hospital cost analysis of a prospective, randomized trial of early vs interval appendectomy for perforated appendicitis in children

Adrianne L. Myers, Regan F. Williams, Kim Giles, Teresa M. Waters, James W. Eubanks, S. Douglas Hixson, Eunice Y. Huang, Max R. Langham, Martin L. Blakely

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Background: The methods of surgical care for children with perforated appendicitis are controversial. Some surgeons prefer early appendectomy; others prefer initial nonoperative management followed by interval appendectomy. Determining which of these two therapies is most cost-effective was the goal of this study. Study Design: We conducted a prospective, randomized trial in children with a preoperative diagnosis of perforated appendicitis. Patients were randomized to early or interval appendectomy. Overall hospital costs were extracted from the hospital's internal cost accounting system and the two treatment groups were compared using an intention-to-treat analysis. Nonparametric data were reported as median ± standard deviation (or range) and compared using a Wilcoxon rank sum test. Results: One hundred thirty-one patients were randomized to either early (n = 64) or interval (n = 67) appendectomy. Hospital charges and costs were significantly lower in patients randomized to early appendectomy. Total median hospital costs were $17,450 (range $7,020 to $55,993) for patients treated with early appendectomy vs $22,518 (range $4,722 to $135,338) for those in the interval appendectomy group. Median hospital costs more than doubled in patients who experienced an adverse event ($15,245 vs $35,391, p < 0.0001). Unplanned readmissions also increased costs significantly and were more frequent in patients randomized to interval appendectomy. Conclusions: In a prospective randomized trial, hospital charges and costs were significantly lower for early appendectomy when compared with interval appendectomy. The increased costs were related primarily to the significant increase in adverse events, including unplanned readmissions, seen in the interval appendectomy group.

Original languageEnglish
Pages (from-to)427-434
Number of pages8
JournalJournal of the American College of Surgeons
Issue number4
StatePublished - Apr 2012

Bibliographical note

Funding Information:
Supported by LeBonheur Children's Hospital Grant and Accredo Pediatric Scientist Award (Dr Blakely).


  • IR
  • IVF
  • RCC
  • RCT
  • interventional radiology
  • intravenous fluids
  • randomized clinical trial
  • ratio of cost to charges

ASJC Scopus subject areas

  • Surgery


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