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Treatment of perforated appendicitis in children: what is the cost?

      Abstract

      Background/Purpose

      We compared direct hospital costs and indirect costs to the family associated with immediate appendectomy or initial nonoperative management for perforated appendicitis in children.

      Methods

      From June 2009 through May 2010, 61 prospectively identified families completed a cost diary, documenting the numbers of missed school days for the child and missed employment days for the adult caregiver(s) over the treatment course. Hospital costs were obtained from hospital financial databases. Mann-Whitney U tests and Fisher exact tests were used to compare outcome measures for each treatment strategy.

      Results

      Patients treated by initial nonoperative management had a significantly longer median length of stay (9 days vs 7 days, P = .02) and a significantly greater median total hospital cost per patient ($31,349 vs $21,323, P = .01) when compared with those treated by immediate appendectomy. There was no significant difference in median number of missed school days (9 days vs 10 days, P = .23) or missed employment days for adult caregiver(s) (5 days vs 7 days, P = .18) between treatment strategies.

      Conclusions

      Patients with perforated appendicitis treated by initial nonoperative management had a greater length of stay and a significantly greater total hospital cost but were not burdened by significantly greater indirect costs compared with those treated by immediate appendectomy.

      Abbreviations:

      BMI (body mass index), CHB (Children's Hospital Boston), CHRIs PR–Demographics (Child Health Ratings Inventory Parent Report–Demographics), IQR (interquartile range), IR (interventional radiology), IRB (institutional review board), IV (intravenous), LOS (length of stay), PICC (percutaneously inserted central catheter), RLQ (right lower quadrant), SD (standard deviation), SSI (surgical site infection), TPN (total parenteral nutrition), UTI (urinary tract infection), WBC (white blood cell.)

      Key words

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