Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals
Kurt Newman1, Todd Ponsky, Kory Kittle
1Department of Surgery, Children's National Medical Center and George Washington University School of Medicine, Washington, DC, USA.
Insights
Pediatric hospitals show wide variation in appendicitis care, impacting outcomes. Adopting best practices can enhance treatment results and resource use for children with appendicitis.
Area of Science:
- Pediatric Surgery
- Healthcare Management
- Clinical Outcomes Research
Background:
- Appendicitis is a common surgical emergency in children.
- Variability in care can lead to suboptimal clinical results and inefficient resource utilization.
Purpose of the Study:
- To analyze current practices and outcomes for pediatric appendicitis care across multiple institutions.
- Identify areas of significant variability in management and resource use.
Main Methods:
- Utilized the Pediatric Health Information System (PHIS) database.
- Analyzed data from 3,393 pediatric appendicitis cases across 30 children's hospitals (Oct 1999-Sep 2000).
- Examined outcomes including nonpositive appendectomy rates, rupture rates, length of stay, readmissions, and diagnostic imaging use.
Main Results:
- Significant variation observed in nonpositive appendectomy rates (median 2.6%) and ruptured appendicitis (median 36.5%).
- Length of stay varied for nonruptured (median 2 days) and ruptured appendicitis (median 6 days).
- Laparoscopic appendectomy use ranged widely (0-95%), with no significant difference in length of stay compared to open procedures.
Conclusions:
- Substantial variability in appendicitis management and resource utilization exists among pediatric hospitals.
- Collaborative efforts to implement evidence-based best practices are recommended to improve pediatric appendicitis care.
Background/Purpose:
To improve clinical results and resource utilization in the care of appendicitis in children, the authors examined the current practice and outcomes of 30 pediatric hospitals.
Methods:
The Pediatric Health Information System (PHIS) database consists of comparative data from 30 free-standing Children's hospitals. The study population of 3,393 children was derived from the database by selecting the "Diagnosis Related Group Code" for appendicitis (APRDRGv12 164), ages 0 to 17 years, using discharges between October 1, 1999 and September 30, 2000. Data are expressed as the range and median for individual hospital outcomes.
Results:
The nonpositive appendectomy rate ranged from 0 to 17% at the 30 hospitals (median, 2.6%). Ruptured appendicitis varied from 20% to 76% (median, 36.5%). The median length of stay (LOS) for nonruptured appendicitis was 2 days (range, 1.4 to 3.1 days), ruptured appendicitis varied from 4.4 to 11 days (median, 6 days). The median readmission rate within 14 days was 4.3% (0 to 10%). Laparoscopic appendectomy varied from 0 to 95% in the 30 hospitals (mean, 31%) The LOS did not vary significantly in laparoscopic versus open for nonruptured (2.3 v 2.0 days) or ruptured appendicitis (5.5 v 6.2 days). Days on antibiotics for ruptured appendicitis ranged from 4.6 to 7.9 days (median, 5.9 days) Children receiving any study varied from 18% to 89% (median, 69%). Ultrasound scan and computed tomography (CT) were comparable in both nonruptured (13% ultrasound scan v 14%) and ruptured appendicitis (14% ultrasound scan v 21% CT).
Conclusions:
Significant variability in practice patterns and resource utilization exists in the management of acute appendicitis in pediatric hospitals. Clinical outcomes could be improved by collaborative initiatives to adopt evidence-based best practices.
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