L. A. Posey1, N. Bhutiani1, M. C. Bozeman1, B. G. Harbrecht1 1University of Louisville,Surgery,Louisville, KY, USA
Introduction: Recent changes in patterns of healthcare delivery of healthcare in Kentucky have stemmed from many elements, including Medicaid expansion and efforts focused on optimizing healthcare resource utilization. This study assessed demographic, diagnosis, and management trends among patients in Kentucky who underwent operative management of acute appendicitis.
Methods: Data from the Kentucky Cabinet Office of Health Policy was queried for all adult patients with who underwent operative intervention for acute appendicitis between 2008 and 2016. Trends in demographics, use of abdominal imaging, and hospital setting in which procedures were performed (inpatient versus short hospital stay (outpatient or <24 hour admission)) were evaluated.
Results: The annual number of patients undergoing operative intervention for acute appendicitis ranged from 4409 (2014) to 5043 (2010). Overall, a greater proportion of patients underwent abdominal imaging as part of their diagnostic workup (39% 2008 to 76% in 2016,r=0.91,p<0.001), and an increasing proportion of patients listed as having a short hospital stay rather than full admission (41% in 2008 to 67% in 2016,r=0.99,p<0.001) after appendectomy (Figure). Insurance status did not change linearly over time. Instead, beginning in 2014, the proportion of patients covered by Medicaid increased by approximately 150% (p=0.004), and the proportion of self-pay or uninsured patients decreased by over 60% (p<0.001), coinciding with Medicaid expansion.
Conclusion: Management of appendicitis has shifted toward including diagnostic imaging and earlier postoperative discharge over time in Kentucky. These trends likely reflect changes in healthcare and hospital practice and may be independent of changes in the insurance landscape.
