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Costs associated with postoperative intra-abdominal abscess in pediatric perforated appendicitis: A retrospective
Dalya M Ferguson1, Seyed A Arshad1, Elenir B C Avritscher2
1Department of Pediatric Surgery, John P. and Katherine G. McGovern Medical School at UTHealth, Houston, TX; Center for Surgical Trials and Evidence-Based Practice (C-STEP), John P. and Katherine G. McGovern Medical School at UTHealth, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX.
Insights
Intra-abdominal abscesses nearly doubled the cost of pediatric perforated appendicitis, increasing hospital stays and expenses. Reducing abscess rates can lead to significant healthcare savings.
Area of Science:
- Pediatric Surgery
- Health Economics
- Infectious Disease Management
Background:
- Intra-abdominal abscess is a common complication of perforated appendicitis.
- The economic impact of intra-abdominal abscesses in children with perforated appendicitis is not well-established.
- Understanding these costs is crucial for resource allocation and healthcare policy.
Purpose of the Study:
- To evaluate resource utilization and associated costs of intra-abdominal abscesses in pediatric perforated appendicitis.
- To quantify the economic burden of this complication in children.
Main Methods:
- Retrospective analysis of pediatric patients (<18 years) undergoing appendectomy for perforated appendicitis (2013-2019).
- Hospital costs were analyzed from the index admission and within 30 days post-operation.
- Generalized linear models adjusted for confounders to determine excess resource use and costs.
Main Results:
- 20% of patients (153/763) developed intra-abdominal abscesses.
- Intra-abdominal abscess increased 30-day readmission risk nearly 8-fold and required 6.1 excess hospital bed days.
- Mean hospital costs were $27,394 for patients with abscess vs. $15,586 without, an incremental cost of $11,809, largely driven by room costs (66% of excess).
Conclusions:
- Postoperative intra-abdominal abscesses nearly doubled pediatric perforated appendicitis costs.
- Estimated excess costs reached $1.8 million during the study period.
- Reducing intra-abdominal abscess rates or hospital bed days can yield substantial healthcare savings.
Background:
Intra-abdominal abscess, the most common complication after perforated appendicitis, is associated with considerable economic burden. However, costs of intra-abdominal abscesses in children are unknown. We aimed to evaluate resource utilization and costs attributable to intra-abdominal abscess in pediatric perforated appendicitis.
Methods:
A single-center retrospective analysis was performed of children (<18 years) who underwent appendectomy for perforated appendicitis (2013-2019). Hospital costs incurred during the index admission and within 30 postoperative days were obtained from the hospital accounting system and inflated to 2019 USD. Generalized linear models were used to determine excess resource utilization and costs attributable to intra-abdominal abscess after adjusting for confounders.
Results:
Of 763 patients, 153 (20%) developed intra-abdominal abscesses. Eighty-one patients with intra-abdominal abscesses (53%) underwent percutaneous abscess drainage. Intra-abdominal abscess was independently associated with a nearly 8-fold increased risk of 30-day readmission (adjusted risk ratio, 7.8 [95% confidence interval, 4.7-13.0]). Patients who developed an intra-abdominal abscess required 6.1 excess hospital bed days compared to patients without intra-abdominal abscess (95% confidence interval, 5.3-7.0). Adjusted mean hospital costs for patients with intra-abdominal abscess totaled $27,394 (95% confidence interval, $25,688-$29,101) versus $15,586 (95% confidence interval, $15,102-$16,069) for patients without intra-abdominal abscess. Intra-abdominal abscess was associated with an incremental cost of $11,809 (95% confidence interval, $10,029-$13,588). Hospital room costs accounted for 66% of excess costs.
Conclusion:
Postoperative intra-abdominal abscess nearly doubled pediatric perforated appendicitis costs, primarily due to more hospital bed days and associated room costs. Intra-abdominal abscesses resulted in estimated excess costs of $1.8 million during the study period. Even small reductions in intra-abdominal abscess rates or hospital bed days could yield substantial health care savings.
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