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Historical changes in the postoperative treatment of appendicitis in children: impact on medical outcome

J L Lelli1, R A Drongowski, S Raviz

  • 1Department of Surgery, C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor 48109-0245, USA.

Journal of Pediatric Surgery
|February 29, 2000
PubMed

Insights

Managed care led to shorter hospital stays for pediatric appendicitis patients without increasing complications. Diagnostic imaging like ultrasound and radiographs may be overused in this patient population.

Area of Science:

  • Pediatric Surgery
  • Health Services Research
  • Medical Economics

Background:

  • Managed care policies in the 1980s aimed to reduce healthcare costs for hospitalized patients.
  • This led to increased pressure on hospitals to shorten patient stays and optimize resource utilization.
  • The impact of these changes on pediatric appendicitis outcomes was previously unknown.

Purpose of the Study:

  • To investigate the hypothesis that market forces have decreased hospital stays and diagnostic testing for pediatric appendicitis.
  • To evaluate the effect of these changes on patient outcomes, including complications.

Main Methods:

  • Retrospective review of 913 pediatric appendicitis patient records from 1974 to 1998.
  • Stratification of patients into perforated appendicitis (PA) and non-perforated appendicitis (NPA) groups.
  • Analysis of demographics, perioperative course, diagnostic testing, complications, and long-term outcomes over time intervals.

Main Results:

  • Children with NPA and PA experienced shorter antibiotic courses and earlier dietary intake, leading to earlier hospital discharge.
  • No significant changes were observed in the time to become afebrile or normalize white blood cell count.
  • Rates of wound infections, abscesses, readmissions, and reoperations remained stable. Diagnostic imaging utilization (radiographs, ultrasonography) was high and unchanged, with computed tomography (CT) use low and decreasing.
  • Bayesian analysis suggested ultrasonography (USN) utilization should be 15%.

Conclusions:

  • Market pressures have created a new treatment paradigm for pediatric appendicitis, characterized by earlier hospital discharge.
  • This shift has not resulted in an increased complication rate.
  • The study indicates potential overuse of ultrasonography and abdominal radiographs in the institution.
Abstract

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