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Variation in practice and resource utilization associated with the diagnosis and management of appendicitis at

Samuel Rice-Townsend1, Jeff N Barnes, Matthew Hall

  • 1*Department of Pediatric Surgery, Children's Hospital Boston-Harvard Medical School, Boston, MA †Children's Hospital Association, Overland Park, KS.

Annals of Surgery
|October 8, 2013
PubMed

Insights

Significant practice variation in appendicitis diagnosis and treatment exists across children's hospitals, impacting patient care and costs. This highlights the need for standardized quality improvement initiatives.

Area of Science:

  • Pediatric Surgery
  • Health Services Research
  • Quality Improvement

Background:

  • Practice variation in healthcare is linked to suboptimal patient outcomes and increased healthcare expenditures.
  • Understanding variation in appendicitis care is crucial for improving efficiency and effectiveness in pediatric hospitals.

Purpose of the Study:

  • To quantify the extent of practice variation in the diagnosis and treatment of appendicitis.
  • To examine interhospital differences in resource utilization and associated costs for pediatric appendicitis care.

Main Methods:

  • Retrospective cohort study of 13,328 pediatric appendicitis cases across 34 children's hospitals.
  • Analysis of variation in diagnostic imaging, laboratory tests, parenteral nutrition (PN), peripherally inserted central catheters (PICC), and hospital costs.
  • Identification of statistical outliers for high and low utilization across all measured parameters.

Main Results:

  • Wide variations observed in preoperative imaging (3.5-fold difference) and laboratory test utilization (5-fold difference).
  • Substantial interhospital differences in postoperative imaging (12-fold), PICC lines (48-fold), and PN use (100-fold) for complicated appendicitis.
  • Significant 4- to 4.6-fold differences in median hospital costs for both uncomplicated and complicated appendicitis cases.

Conclusions:

  • Considerable practice variation in appendicitis management exists among freestanding children's hospitals.
  • The findings underscore the necessity for value-based measures to benchmark performance and guide quality improvement efforts.
  • Collaborative initiatives are needed to standardize care and reduce unwarranted variation in pediatric appendicitis treatment.
Abstract

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