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Outcomes and costs of pediatric appendectomies at rural hospitals

Cynthia M Tom1, Scott Friedlander2, Rie Sakai-Bizmark2

  • 1Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA 90502, USA.

Journal of Pediatric Surgery
|November 4, 2018
PubMed

Insights

Pediatric appendectomies at rural hospitals show higher negative appendectomy rates and more complications, despite treating less severe appendicitis. Further research is needed to improve rural pediatric surgical care quality.

Area of Science:

  • Pediatric Surgery
  • Health Services Research
  • Rural Health

Background:

  • Quality and safety of pediatric surgical care in rural settings are understudied.
  • Policy efforts aim to support rural hospitals, but outcomes data are limited.

Purpose of the Study:

  • To determine the outcomes and costs of appendectomies performed on children in rural hospitals.
  • To compare pediatric appendectomy care between rural and urban facilities.

Main Methods:

  • Analysis of the Kids' Inpatient Database (2003-2012) for pediatric appendectomies.
  • Inclusion of data on disease severity, surgical approach (laparoscopy), complications, length of stay (LOS), and cost.
  • Utilized bivariate and multivariable regression analyses for outcome assessment.

Main Results:

  • Rural hospitals performed 13.6% of pediatric appendectomies.
  • Associated with higher negative appendectomy rates (OR 1.49) and complication rates (OR 1.29).
  • Showed decreased appendiceal perforation rates (OR 0.86) and less laparoscopy use (OR 0.48), with shorter LOS and slightly increased costs.

Conclusions:

  • Rural hospitals manage fewer advanced appendicitis cases but have higher negative appendectomy rates and complications.
  • Lower rates of laparoscopy were observed in rural pediatric appendectomies.
  • Further investigation is required to address disparities and enhance pediatric surgical care quality in rural areas.
Abstract

Keywords:
AppendicitisCostsOutcomesPediatricRuralUrban

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