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National Trends in Hospitalizations for Appendectomy in Children, 2001-2017
Ludmilla Candido Santos1, Jingya Gao1, Ronaldo C Fabiano Filho1
1Massachusetts General Hospital, Department of Emergency Medicine, Boston, United States.
Insights
Pediatric appendectomy hospitalizations declined significantly between 2001 and 2017, but the median cost of the procedure increased by 61%. These trends highlight the need for evidence-based guidelines to optimize appendicitis care and resource allocation.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Epidemiology
Background:
- Appendectomy for acute appendicitis is the most common acute surgical procedure in children.
- Recent shifts in appendicitis management protocols may impact hospitalization patterns and costs.
Purpose of the Study:
- To analyze temporal trends in pediatric appendectomy hospitalizations from 2001 to 2017.
- To assess changes in hospitalization costs and length of stay associated with appendectomy incidence.
- To examine patient, hospital, and geographic variations in appendectomy outcomes.
Main Methods:
- Cross-sectional study utilizing data from the National Inpatient Sample (2001-2017).
- Analysis of temporal changes in appendectomy hospitalization incidence, cost, and length of stay.
- Inclusion of patient and hospital characteristics, as well as geographic data, to identify outcome disparities.
Main Results:
- Appendectomy hospitalization incidence decreased from 11.2 to 6.4 per 10,000 person-years (2001-2017).
- Median procedure cost increased by 61% during the study period.
- Temporal trends in appendectomy hospitalizations varied by patient, hospital, and geographic factors.
Conclusions:
- A substantial decrease in pediatric appendectomies was observed, contrasted by a significant rise in procedure costs.
- Understanding the drivers of these trends is crucial for developing evidence-based guidelines.
- Optimizing clinical decisions and resource utilization in pediatric appendicitis management is essential.
Objective:
Appendectomy for acute appendicitis is the most common acute surgical procedure in children. Recent changes in appendicitis management have likely modified the nature and cost of hospitalizations for this condition.
Methods:
Using data from the National Inpatient Sample from 2001 to 2017, we performed a cross-sectional study and identified the temporal changes in hospitalization for appendectomy. Changes in relative hospitalization cost and length-of-stay were also studied to assess their associations with the changes in procedure incidence. Patient and hospital characteristics were considered to understand outcome disparities between groups. Geographic variation in the outcomes was also identified at the United States region and division levels.
Results:
The incidence of appendectomy hospitalization decreased from 11.2 to 6.4 per 10,000 person-years between 2001 and 2017. Conversely, the median procedure cost increased 61% during this same period. The temporal changes in appendectomy hospitalization varied according to patient and hospital characteristics, as well as geographic locations.
Conclusion:
The overall incidence of appendectomies in children decreased substantially from 2001 to 2017, yet the trend for costs was in the opposite direction. The data on the clinical factors driving these trends can be useful in guiding policies with evidence-based guidelines that help optimize clinical decisions and the effective use of resources in the management of appendicitis.
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