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Specialty versus generalist care of children with appendicitis: an outcome comparison
F Alexander1, D Magnuson, J DiFiore
1Cleveland Clinic Foundation, The Cleveland Clinic Children's Hospital, Department of Pediatric Surgery, Cleveland, OH 44195, USA.
Insights
Health Maintenance Organizations (HMO) policies limiting specialist access may impact pediatric appendicitis outcomes. Children with perforated appendicitis treated by pediatric surgeons experienced fewer complications and shorter hospital stays than those treated by general surgeons.
Area of Science:
- Pediatric Surgery
- Health Services Research
Background:
- Health Maintenance Organizations (HMOs) often restrict specialist access to control costs.
- The impact of these restrictions on pediatric appendicitis outcomes is not well understood.
Purpose of the Study:
- To evaluate whether HMO policies affect treatment outcomes for children with appendicitis.
- To compare outcomes between children treated by an HMO general surgical service versus a pediatric surgical service.
Main Methods:
- A retrospective study at an academic medical center comparing children (≤17 years) with appendicitis.
- Group A: Treated by HMO Adult General Surgical Service; Group B: Treated by Pediatric Surgical Service.
- Analysis included imaging, operation type, complications, readmissions, and length of stay, using chi-squared and Fischer's Exact tests.
Main Results:
- No significant differences in outcomes for simple acute appendicitis between groups.
- For gangrenous or perforated appendicitis, Group B (pediatric surgeons) had significantly fewer complications, readmissions, and second operations.
- Group B also had a significantly shorter mean length of hospital stay for complicated appendicitis.
Conclusions:
- Pediatric surgeons provide better outcomes for children with complicated appendicitis compared to general surgeons within an HMO setting.
- Specialized pediatric surgical care is associated with reduced complications and shorter hospitalizations for severe appendicitis cases.
Background/Purpose:
Some Health Maintenance Organizations (HMO) limit access of their members to specialists to lower costs. The purpose of this study is to determine whether this policy affects the outcome of children with appendicitis.
Methods:
At a large academic medical center, children 17 years or younger with appendicitis were treated either by an HMO Adult General Surgical Service (group A) or a Pediatric Surgical Service (group B). Board certified pediatric surgeons were not available on the HMO surgical service. Anesthesia, surgical residents, nursing, and ancillary support services were identical in both groups. Study parameters included imaging tests performed, operation type, complications, readmissions, and length of stay. Results were analyzed using chi(2) and Fischer's Exact tests.
Results:
One-hundred seventy-five consecutive children underwent appendectomy, 96 in group A and 79 in group B. In patients with simple acute appendicitis, there was no significant difference between group A and group B for complications, readmissions, second operation, or length of stay. In patients with gangrenous or perforated appendicitis there was a significant difference between group A and group B for type of operation (laparoscopic appendectomy, group A, 4 of 27 v. group B, 0 of 34; P =.04); complications (group A, 9 of 27 v. group B, 3 of 34; P =.025); readmissions (group A, 6 of 27 v. group B, 0 of 34; P =.001); second operation (group A, 6 of 27 v. group B, 2 of 34; P =.001); and mean total length of stay in days (group A, 8.6 of 27 v. group B, 5.4 of 34; P =.05).
Conclusions:
Children with significantly perforated appendicitis have lower complication rates and shorter lengths of hospital stay when treated by pediatric surgeons as compared with HMO adult general surgeons.
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