C. Tom1, R. P. Won1, E. Saab2, A. D. Lee2, S. Friedlander3, S. L. Lee1,2,3 1Harbor-University Of California Los Angeles Medical Center,Department Of Surgery,Torrance, CA, USA 2University Of California Los Angeles,Department Of Surgery,Los Angeles, CA, USA 3Los Angeles Biomedical Research Institute,Torrance, CA, USA
Introduction: The benefits of managing children after pediatric surgical procedures or injury at children’s hospitals (CH) are well established. However, little is known about the outcomes and costs of managing common pediatric surgical procedures at non-children’s hospitals (NCH). The purpose of this study is to compare the outcomes and costs of appendectomy and cholecystectomy between CH and NCH.
Methods: Using the Kids’ Inpatient Database (KID), we compared costs and outcomes for pediatric patients (< 18 years old) who underwent appendectomy and cholecystectomy in 2003, 2006, 2009, and 2012 at CH and NCH. We analyzed the patient demographics, complexity of disease, surgical management (rate of laparoscopy), length of stay (LOS), morbidity, and costs between CH and NCH.
Results: The majority of appendectomies (NCH = 223,924 vs CH = 83,048) and cholecystectomies (NCH = 18,406 vs CH = 8,774) were performed at NCH. Overall, CH cared for younger children, had higher costs, and increased LOS compared to NCH. Results of the univariate analysis are summarized in the table. On multivariate analysis for appendectomies, CH treated younger children with higher rates of perforated appendicitis, and were associated with increased use of laparoscopy, longer LOS, lower complication rates, and higher costs. Conversely, multivariate analysis for cholecystectomy demonstrated that CH were associated with decreased use of laparoscopy, longer LOS, and higher costs with no difference in the complication rate compared to NCH.
Conclusion: Variations in surgical management, outcomes, and costs related to common surgical procedures in children exist between CH and NCH. Appendectomies at CH are associated with improved outcomes and higher utilization of laparoscopy despite treating more advanced disease, but have longer LOS and higher costs. Cholecystectomies at CH are associated with no difference in outcomes, but are less likely to utilize laparoscopy, have longer LOS, and higher costs. Opportunities exist at both CH and NCH to improve the quality of care and lower expenses for common surgical diseases in children.
