Abstract
Introduction
The purpose of this study was to characterize epidemiologic trends and cost implications
of hospital readmission after treatment of pediatric appendicitis.
Methods
We conducted a 5-year retrospective cohort analysis of 30-day readmission rates for
52,054 patients admitted with appendicitis at 38 children's hospitals participating
in the Pediatric Health Information System database. Patients were categorized as
“uncomplicated” (postoperative length of stay [LOS] ≤2 days) or “complicated” (LOS
≥3 days and ≥4 consecutive days of antibiotics) and analyzed for demographic data,
treatment received during the index admission, readmission rates, and excess LOS and
hospital-related costs attributable to readmission encounters.
Results
The aggregate 30-day readmission rate was 8.7%, and this varied significantly by disease
severity and management approach (uncomplicated appendectomy, 5.6%; complicated appendectomy,
12.8%; drainage, 22.6%; antibiotics only, 24.6%; P < .0001). The median hospital cost per case attributable to readmission was $3401
(reflecting a 44% relative increase in cumulative treatment-related cost), and this
varied significantly by disease severity and management approach (uncomplicated appendectomy,
$1946 [31% relative increase]; complicated appendectomy, $6524 [53% increase]; drainage,
$6827 [48% increase]; antibiotics only, $5835 [58% increase]; P < .0001).
Conclusion
In freestanding children's hospitals, readmission after treatment of pediatric appendicitis
is a relatively common and costly occurrence. Collaborative efforts are needed to
characterize patient, treatment, and hospital-related risk factors as a basis for
developing preventative strategies.
Key words
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Article info
Publication history
Accepted:
March 6,
2012
Received:
February 25,
2012
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
