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



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


      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.


      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.


      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.


      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Raval M.V.
        • Lautz T.
        • Reynolds M.
        • et al.
        Dollars and sense of interval appendectomy in children: a cost analysis.
        J Pediatr Surg. 2010; 45: 1817-1825
        • Vane D.W.
        • Fernandez N.
        Role of interval appendectomy in the management of complicated appendicitis in children.
        World J Surg. 2006; 30: 51-54
        • Weiner D.J.
        • Katz A.
        • Hirschl R.B.
        • et al.
        Interval appendectomy in perforated appendicitis.
        Pediatr Surg Int. 1995; 10: 82-85
        • Garcia Peña B.M.
        • Taylor G.A.
        • Lund D.P.
        • et al.
        Effect of computed tomography on patient management and costs in children with suspected appendicitis.
        Pediatrics. 1999; 104: 440-446
        • Garcia Peña B.M.
        • Taylor G.A.
        • Fishman S.J.
        • et al.
        Costs and effectiveness of ultrasonography and limited computed tomography for diagnosing appendicitis in children.
        Pediatrics. 2000; 106: 672-676
        • Axelrod D.A.
        • Sonnad S.S.
        • Hirschl R.B.
        An economic evaluation of sonographic examination of children with suspected appendicitis.
        J Pediatr Surg. 2000; 35: 1236-1241
        • Keckler S.J.
        • Tsao K.
        • Sharp S.W.
        • et al.
        Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess.
        J Pediatr Surg. 2008; 43: 977-980
        • St Peter S.D.
        • Aguayo P.
        • Fraser J.D.
        • et al.
        Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trial.
        J Pediatr Surg. 2010; 45: 236-240
        • Fike F.B.
        • Mortellaro V.E.
        • Juang D.
        • et al.
        The impact of postoperative abscess formation in perforated appendicitis.
        J Surg Res. 2011; 170: 24-26
        • Woolford S.J.
        • Gebremariam A.
        • Clark S.J.
        • et al.
        Incremental hospital charges associated with obesity as a secondary diagnosis in children.
        Obesity. 2007; 15: 1895-1901
        • Silber J.H.
        • Gleeson S.P.
        • Zhao H.
        The influence of chronic disease on resource utilization in common acute pediatric conditions.
        Arch Pediatr Adolesc Med. 1999; 153: 169-179
        • Emil S.G.S.
        • Taylor M.B.
        Appendicitis in children treated by pediatric versus general surgeons.
        J Am Coll Surg. 2007; 204: 34-39
        • Warner B.W.
        • Kulick R.M.
        • Stoops M.M.
        • et al.
        An evidence-based clinical pathway for acute appendicitis decreases hospital duration and cost.
        J Pediatr Surg. 1998; 33: 1371-1375
        • Firilas A.M.
        • Higginbotham P.H.
        • Johnson D.D.
        • et al.
        A new economic benchmark for surgical treatment of appendicitis.
        Am Surg. 1999; 65: 769-773
        • Stovroff M.C.
        • Totten M.
        • Glick P.L.
        PIC lines save money and hasten discharge in the care of children with ruptured appendicitis.
        J Pediatr Surg. 1994; 29: 245-247
        • Newman K.
        • Ponsky T.
        • Kittle K.
        • et al.
        Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals.
        J Pediatr Surg. 2003; 38: 372-379
        • St. Peter S.D.
        • Little D.C.
        • Calkins C.M.
        • et al.
        A simple and more cost-effective antibiotic regimen for perforated appendicitis.
        J Pediatr Surg. 2006; 41: 1020-1024
        • Blakely M.L.
        • Williams R.
        • Dassinger M.S.
        • et al.
        Early vs interval appendectomy for children with perforated appendicitis.
        Arch Surg. 2011; 146: 660-665
        • Parsons S.K.
        • Shih M.C.
        • Mayer D.K.
        • et al.
        Preliminary psychometric evaluation of the Child Health Ratings Inventories (CHRIs) and Disease-Specific Impairment Inventory-Hematopoietic Stem Cell Transplantation (DSII-HSCT) in parents and children.
        Qual Life Res. 2005; 14: 1613-1625
        • Mangram A.J.
        • Horan T.C.
        • Pearson M.L.
        • et al.
        Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee.
        Am J Infect Control. 1999; 27: 97-132