D. Ayo1, J. Fusco2, J. Fisher1, H. Ginsburg1, K. Kuenzler1, S. Tomita1 1New York University School Of Medicine,Surgery,New York, NY, USA 2Beth Israel Medical Center,Surgery,New York, NY, USA
Purpose: The pediatric hospitalist movement is growing and has largely followed the model of adult hospitalists with broadening of the hospitalist practice to include surgical patients, with little data on outcomes. This study compared the outcomes of a pediatric surgical condition, perforated appendicitis, in two models—one where patients are managed by pediatric hospitalists with pediatric surgeons consulting and one where patients are managed by pediatric surgeons.
Methods: We reviewed the data of patients aged under 13 with perforated appendicitis from 2002 to 2012 in two health systems—one where patients are admitted to the pediatric surgical service and one where patients are admitted to the pediatric hospitalist service with surgeons as consultants. The patients included those operated on and those managed nonoperatively. Data was analyzed for age, sex, admissions, length of stay, laboratory tests, consults (excluding pediatrics and surgery), ultrasounds, CT scans, total imaging tests, radiology (IR) procedures, and PICC (peripherally inserted central catheter) lines. Continuous variables were reported as means ± standard error and compared using 2-tailed unpaired t tests. Nonparametric variables were analyzed by Mann-Whitney U tests and reported as medians ± interquartile ranges. Categorical variables were compared using Chi-square testing. Statistical significance was accepted for p < .05.
Results: 52 patients were identified in the surgery group (SG) and 19 patients were identified in the hospitalist group (HG). Treatment and outcomes related characteristics of each group are shown in Table 1. Compared to the SG, the HG patients had a statistically significant higher number of laboratory tests, consults, and imaging tests. The SG patients were more likely to have ultrasound exams while the HG patients trended toward the use of more CT scans. There was little difference in the number of patients undergoing IR procedures or PICC lines. The total length of stay was greater in the HG but this did not reach statistical significance.
Conclusions: Pediatric patients with perforated appendicitis managed by pediatric hospitalists are exposed to a more laboratory tests, consults, and imaging studies which may add to hospital costs and resource use as compared to those managed by pediatric surgeons. There may be nuances in managing a surgical disease which are better appreciated by a surgeon. Also, a pediatric surgeon may be better acquainted with the use of ultrasound in appendicitis which has consequences regarding radiation exposure. This implies that surgical diseases such as perforated appendicitis are more effectively managed by pediatric surgeons with pediatric hospitalists as consultants.
