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Interval appendectomy in children clinical outcomes, financial costs and patient benefits
David Fawkner-Corbett1, Wajid B Jawaid, Jo McPartland
1Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, University of Liverpool, Liverpool, UK.
Insights
Elective interval appendectomy for pediatric appendiceal mass is often unnecessary, with only 12% experiencing recurrent appendicitis. This approach may not be essential, potentially saving the NHS significant costs per patient.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Elective interval appendectomy (IA) is a common approach for pediatric appendiceal mass (AM).
- Evidence supporting IA and its associated costs remains unclear, with a lack of randomized controlled trials.
- This study evaluates clinical outcomes, patient benefits, and financial implications of IA at a UK pediatric surgical center.
Purpose of the Study:
- To assess the necessity and outcomes of elective interval appendectomy (IA) in children with appendiceal mass (AM).
- To analyze the recurrence rate of appendicitis after initial management of AM.
- To evaluate the financial impact of IA versus immediate appendectomy on healthcare costs.
Main Methods:
- Retrospective analysis of 69 children with AM from 1997-2011.
- Inclusion of pathology records and hospital admission codes for patient identification.
- Calculation of tariff costs for admissions between 2007-2011.
Main Results:
- Only 12% of children experienced recurrent appendicitis after initial AM management.
- Elective interval appendectomy (IA) was performed in 88% of cases; 12% required emergency readmission for appendectomy.
- Laparoscopic IA was associated with shorter hospital stays (3 days) compared to open appendectomy (2 days).
- Median cost for IA was £1,936, with higher costs for emergency appendectomies (£2,171).
Conclusions:
- Recurrent appendicitis after initial AM management is infrequent (12%).
- Both interval and emergency appendectomies demonstrated low morbidity.
- IA may be non-essential, and avoiding it could lead to substantial cost savings for the NHS.
Background:
Elective interval appendectomy (IA) is traditionally advocated for the management of appendiceal mass (AM) in children. Surgeons have debated the evidence and 'risks' vs. 'benefits' to support IA. There are currently no randomised controlled trials and guiding best practice and financial costings for IA are lacking. We herein report clinical outcomes, patient benefits and tariff charges linked with the provision of IA at a regional UK paediatric surgical centre.
Methods:
Hospital case records of patients with AM were identified using pathology records and hospital admission codes during a 15-year period (1997-2011). Tariff costs (£ Sterling) were calculated for all admissions during the era 2007-2011.
Results:
69 children were admitted with AM (61% female, median age 10.5 years, range 2.1-16 years). Median initial hospital stay with resolution of symptoms was 8 days (range 3-14 days). 61 children (88%) had elective IA (median interval 76 days, range 29-230 days). Eight (12 %) patients required emergency readmission for early appendectomy (median interval 21 days, range 6-51 days). Hospital stay for emergency readmission appendectomy in these children was significantly longer than IA (median 6 vs. 3 days, p < 0.01). Laparoscopic appendectomy vs. 'open' appendectomy was associated with shorter length of stay in the IA cohort (median 3 vs. 2 days p < 0.01). No intra-operative morbidity was recorded in the study with only a single case developing a post-operative wound infection. Median cost for IA was £1,936. Costings were higher in the emergency appendectomy group-£2,171 vs. 1,936; p = 0.09, NS.
Conclusion:
Only 12% of children at this centre develop recurrent appendicitis after primary admission with AM. Interval and emergency appendectomy were associated with low morbidity. Parents should be informed that IA may be 'non essential' surgery. Paediatric surgeons not routinely advocating IA can potentially save the NHS £1,936 per patient. Future randomised studies are warranted to confirm or refute these findings.
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