TY - JOUR
T1 - Hospital cost analysis of a prospective, randomized trial of early vs interval appendectomy for perforated appendicitis in children
AU - Myers, Adrianne L.
AU - Williams, Regan F.
AU - Giles, Kim
AU - Waters, Teresa M.
AU - Eubanks, James W.
AU - Hixson, S. Douglas
AU - Huang, Eunice Y.
AU - Langham, Max R.
AU - Blakely, Martin L.
N1 - Funding Information:
Supported by LeBonheur Children's Hospital Grant and Accredo Pediatric Scientist Award (Dr Blakely).
PY - 2012/4
Y1 - 2012/4
N2 - 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.
AB - 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.
KW - IR
KW - IVF
KW - RCC
KW - RCT
KW - interventional radiology
KW - intravenous fluids
KW - randomized clinical trial
KW - ratio of cost to charges
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U2 - 10.1016/j.jamcollsurg.2011.12.026
DO - 10.1016/j.jamcollsurg.2011.12.026
M3 - Article
C2 - 22342789
AN - SCOPUS:84862815789
SN - 1072-7515
VL - 214
SP - 427
EP - 434
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 4
ER -