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Beyond perforation: Influence of peritoneal contamination on clinical severity and resource utilization in children
Christina Feng1, Seema Anandalwar1, Feroze Sidhwa1
1Boston Children's Hospital, Department of Surgery.
Insights
Extensive peritoneal contamination in children with appendicitis significantly increases resource use. This includes longer hospital stays, higher costs, and more readmissions compared to localized contamination.
Area of Science:
- Pediatric Surgery
- Healthcare Resource Management
- Clinical Outcomes Research
Background:
- Complicated appendicitis in children can lead to varying degrees of peritoneal contamination.
- Understanding the impact of contamination severity on healthcare resource utilization is crucial for effective management and cost analysis.
Purpose of the Study:
- To investigate the association between the extent of peritoneal contamination and postoperative resource utilization in pediatric complicated appendicitis.
- To compare resource utilization metrics between localized and extensive peritoneal contamination groups.
Main Methods:
- Prospective data collection from 88 children with complicated appendicitis (2012-2014).
- Categorization of peritoneal contamination as localized or extensive based on intraoperative findings.
- Comparison of postoperative imaging rates, length of stay (pLOS), hospital costs, and readmission rates between the two contamination groups.
Main Results:
- Children with extensive contamination (38% of cases) showed significantly higher postoperative imaging utilization (58.8% vs 27.7%).
- Extensive contamination was linked to a 50% longer median pLOS (6 vs 4 days) and 30% higher median hospital costs ($17,663 vs $13,516).
- Readmission rates were nearly four-fold higher in the extensive contamination group (20.6% vs 5.6%).
Conclusions:
- Extensive peritoneal contamination in pediatric complicated appendicitis is a significant driver of increased healthcare resource utilization.
- Findings highlight the need for severity adjustment in reimbursement and readmission reporting, especially in areas with late presentations.
Purpose:
The purpose of the study was to explore the relationship between the degree of peritoneal contamination and postoperative resource utilization in children with complicated appendicitis.
Methods:
Intraoperative findings were collected prospectively at a single children's hospital from 2012 to 2014. The degree of peritoneal contamination was categorized as either "localized" (confined to the right lower quadrant and pelvis) or "extensive" (extending to the liver). Imaging utilization, postoperative length of stay (pLOS), hospital cost, and readmission rates were compared between groups.
Results:
Of 88 patients with complicated appendicitis, 38% had extensive contamination. Preoperative characteristics were similar between groups. Patients with extensive contamination had higher rates of postoperative imaging (58.8% vs 27.7%, P<0.01), a 50% longer median pLOS (6days [IQR 4-9] vs 4days [IQR 2-5], P=0.003), a 30% higher median hospital cost ($17,663 [IQR $12,564-$23,697] vs $13,516 [IQR $10,546-$16,686], P=0.004), and a nearly four-fold higher readmission rate (20.6% vs 5.6%, P=0.04) compared to children with localized contamination.
Conclusion:
Extensive peritoneal contamination is associated with significantly higher resource utilization compared to localized contamination in children with complicated appendicitis. These findings may have important severity-adjustment implications for reimbursement and readmission rate reporting for hospitals that serve populations where late presentation is common.
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