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Rethinking hospital postoperative resource use: A national analysis of pediatric appendectomy patients admitted to
Suhail Zeineddin1, J Benjamin Pitt2, Michela Carter2
1Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, IL. Electronic address: https://www.twitter.com/szeineddinMD.
Insights
Over a third of pediatric appendicitis patients experienced potentially avoidable hospital days. Exploring remote monitoring could enable earlier discharge and reduce healthcare costs for these cases.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Hospital Resource Utilization
Background:
- Postoperative inpatient care and healthcare costs are significant concerns.
- Limited understanding exists regarding current hospital resource use patterns following pediatric appendectomy.
- Remote monitoring and telemedicine may offer solutions for reducing inpatient stays and costs.
Purpose of the Study:
- To describe hospital resource utilization patterns in pediatric patients after appendectomy for complicated appendicitis.
- To evaluate the potential for earlier patient discharge utilizing remote monitoring strategies.
Main Methods:
- Retrospective cohort study utilizing the Pediatric Health Information System database (2016-2021).
- Analysis of healthcare resource use and costs (antibiotics, IV fluids, analgesics, labs, imaging) via administrative billing data.
- Definition of potentially avoidable days as nondischarge days without specific pain management or fluid support codes; employed descriptive statistics and logistic regression.
Main Results:
- Out of 24,165 patients, 34.3% had at least one potentially avoidable hospitalization day (14.2% of total days).
- Median hospitalization cost was $19,434, with accommodation and operating room costs being highest.
- Public insurance and minority status were linked to increased odds of avoidable days; prolonged IV antibiotic and opioid use were common.
Conclusions:
- Over one-third of pediatric appendicitis patients experienced potentially avoidable hospitalization days.
- Remote monitoring and telemedicine should be investigated to facilitate earlier discharge and reduce healthcare expenditures.
- Optimizing postoperative care pathways can improve resource allocation and patient outcomes.
Background:
The increased use of remote monitoring and telemedicine support may help alleviate the need for some of the postoperative inpatient hospital care and reduce health care costs, but little is known about current postoperative hospital resource use patterns. We aim to describe hospital resources use patterns in pediatric patients postappendectomy for complicated appendicitis and to evaluate the potential of earlier discharge with remote monitoring.
Methods:
This was a retrospective cohort study using the Pediatric Health Information System database for patients who underwent laparoscopic appendectomy for complicated appendicitis between 2016 and 2021. Health care use/costs (antibiotics, intravenous fluids [proxy for diet], analgesics, laboratory studies, and imaging tests) were determined using administrative billing data. Potentially avoidable days were defined as nondischarge days without codes for intravenous opioid pain medication or intravenous fluids. Descriptive statistics and logistic regression were used.
Results:
In total, 24,165 patients were included: 8,300 patients (34.3%) had at least 1 potentially avoidable hospitalization day, totaling 13,970 days or 14.2% of all hospitalization days. Median hospitalization cost was $19,434 [$15,658-$25,157], with accommodation and operating room being the greatest contributors. Public insurance and minority races and ethnicities were associated with greater odds of potentially avoidable days. More than 80% of hospitalized patients had intravenous antibiotics through 10 days postoperatively. More than 20% received opioids daily.
Conclusions:
More than one third of the patients who underwent laparoscopic appendectomy for complicated appendicitis could have had at least 1 potentially avoidable hospitalization day. Remote monitoring and telemedicine support should be explored and could help with earlier discharge and lower costs.
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