91.11 Trends in Treatment of Appendicitis: Analysis of National Inpatient Sample

T. Chkhikvadze1, J. Shi2, P. Sinha3  3NYU Langone Hospital-Brooklyn,Department Of Surgery, NYU School Of Medicine,Brooklyn, NY, USA 1NYU Langone Hospital-Brooklyn,Department Of Medicine, NYU School Of Medicine,Brooklyn, NY, USA 2Ohio State University,The Research Institute At Nationwide Children’s Hospital,Columbus, OH, USA

Aim of the study: To assess if attempts of conservative management of acute appendicitis (AA) have changed delivery of surgical care for this disease in the United States.

Methods: We analyzed 10 years of National Inpatient Sample (NIS) database by extracting all discharges across 2005-2014yy with associated ICD-9 diagnosis and procedure codes for appendicitis (540, 541, 542) and appendectomy, including drainage of appendiceal abscesses (DAA) (47.0, 47.01, 47.2).  National estimates were calculated.  Trends and available demographics were reviewed. Mean length of stay (LOS) and mean charges (MC) adjusted by inflation index were analyzed and stratified by age groups. Open and laparoscopic appendectomy discharges were analyzed separately for all billable data provided in each discharge abstract.

Results: Number of total appendicitis discharges (NTAD) has decreased throughout the examined years from 318,022 to 217,490. We observed increase in MC from $26,453 to $45,441 for each AA discharge (Table 1). Number of open appendectomies (OAP) has significantly decreased, while number of laparoscopic appendectomies (LAP) has remained the same after initial increase (Figure 1). DAA has increased from 1,515 to 2,780 with no significant change in diagnosis for AA with peritoneal abscess. Despite significant decrease in OAP, the cost of treatment has doubled across all ages and LOS has increased (Table 2).  Cost of LAP increased as well.

Conclusion: Hospitalizations with diagnosis of AA have decreased throughout 2005-2014yy while mean charges have increased per discharge.  Number of OAP has decreased by 80% and cost has doubled from $25,000 to $53,000. Number of LAP procedures remained the same across all age groups with increase in cost. DAA has increased. Overall mean cost of treatment of AA has increased from $26,453 to $45,441US. Above data is reflecting the shift of AA diagnosis and treatment away from inpatient status. The patients that end up hospitalized tend to have more severe disease requiring complex care, which translates into increased cost and LOS.