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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.
Journal of Pediatric Surgery
|March 13, 2003
Summary
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.