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Effect of pediatric surgical practice on the treatment of children with appendicitis
E R Kokoska1, R K Minkes, M L Silen
1Division of Pediatric Surgery, Department of Surgery, Cardinal Glennon Children's Hospital, 1465 South Grand Blvd, St Louis, MO 63104, USA.
Insights
Pediatric surgeons (PSs) provide more cost-effective appendicitis care for younger children, reducing hospital stays and charges compared to general surgeons (GSs). This finding highlights the economic benefits of specialized care for pediatric appendicitis patients.
Area of Science:
- Pediatric Surgery
- Health Economics
- Surgical Outcomes
Background:
- Appendicitis management in children involves both general surgeons (GSs) and pediatric surgeons (PSs).
- Variations in surgical approach may influence patient outcomes and healthcare costs.
Purpose of the Study:
- To compare the economic impact of surgical care for appendicitis provided by GSs versus PSs in children.
- To analyze cost-effectiveness based on surgeon specialty and patient age.
Main Methods:
- Retrospective comparison of children undergoing appendicitis surgery between January 1994 and June 1997.
- Data analyzed by surgeon type (GSs vs. PSs), patient age, and diagnosis (simple vs. perforated appendicitis).
- Statistical analysis included ANOVA for continuous data and chi-squared for nominal data.
Main Results:
- GSs treated older children (11.0 yrs) than PSs (9.1 yrs) and had lower rates of perforated appendicitis (18.8% vs 31.9%).
- Younger children (0-12 yrs) treated by PSs experienced shorter hospital stays and lower hospital charges, regardless of appendicitis severity.
- Older children (13-15 yrs) showed comparable outcomes between GSs and PSs.
Conclusions:
- Pediatric surgeons (PSs) offer more economical appendicitis treatment for younger pediatric patients.
- Specialized surgical care by PSs is associated with reduced hospital resource utilization and costs in pediatric appendicitis.
Objective:
Acute appendicitis in children is managed by both general surgeons (GSs) and pediatric surgeons (PSs). Our objective was to investigate the economics of surgical care provided by either GSs or PSs for appendicitis.
Methods:
The outcome of children within our state who underwent operative treatment for appendicitis (January 1994 to June 1997) by board-certified GSs were compared with the results of PSs. Data were sorted according to patient age and diagnosis according to the International Classification of Diseases, Ninth Revision. Analysis of variance was performed on continuous data, and chi(2) analysis was performed on nominal data; data are depicted as mean +/- standard error of the mean.
Results:
GSs (n = 2178) managed older children when compared with PSs (n = 1018; 11.0 +/- 0.1 vs 9.1 +/- 0.1 years) and less frequently treated perforated appendicitis (18.8% vs 31.9%). Independent of diagnosis (simple or perforated appendicitis), younger children (0-4 years, 5-8 years, and 9-12 years) who were treated by PSs had a significantly shorter hospital stay and/or decreased hospital charge when compared with those who were treated by GSs. However, older children (13-15 years) seemed to have comparable outcomes.
Conclusions:
Younger children with appendicitis have reduced hospital days and charges when they are treated by PSs.
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