J. T. Church1, E. J. Klein1, B. D. Carr1, S. W. Bruch1 1University Of Michigan,Ann Arbor, MI, USA
Introduction: Perforated appendicitis can be managed with early appendectomy, or non-operative management with antibiotics with or without percutaneous drainage, followed by interval appendectomy. It is unclear which management strategy is best. We aimed to identify the strategy with the lowest hospital costs.
Methods: We retrospectively reviewed the medical records of all children ≤18yo with perforated appendicitis admitted to a single institution between January, 2009 and March, 2016. Patients were included if their admission history and physical noted perforated appendicitis or suspected perforated appendicitis as the admission diagnosis; they were excluded if they were immunosuppressed, or if they were transferred from an outside hospital (OSH) after initiation of care. Data collected included demographics, diagnostic studies and labs, management strategy, and financial data. The primary outcome was total hospital cost collected over two years starting on the date of admission. Comparisons were made using t-test, with statistical significance defined as p<0.05.
Results: 203 children with perforated appendicitis were identified. After exclusion of immunosuppressed patients and OSH transfers, 103 patients were included in the study. The average age at initial admission was 9.5±4.5 years old, and 58% of patients were male. 42 children underwent early appendectomy, while 61 underwent initial non-operative management, 60 of whom underwent interval appendectomy. Five of the 61 (8%) patients who underwent initial non-operative management failed and required appendectomy prior to elective interval appendectomy. There was no difference in total cost for the initial admission between early appendectomy and interval appendectomy (15190±8982 vs. 15043±10430; p=0.94). However, total two-year hospital costs were 19045±13773 in the early appendectomy group compared to 26228±17830 in the interval appendectomy group (p=0.023).
Conclusion: Early appendectomy appears to result in lower hospital costs compared to initial non-operative management with elective interval appendectomy. A prospective study will shed more light on this question, and can assess the role of non-operative management without interval appendectomy in children with perforated appendicitis.