Association of hospital profit status with operative rates for acute appendicitis

Although appendicitis can now be treated nonoperatively, the uptake of nonoperative management of appendicitis (NOM) has been slow. We explored patient and hospital factors that might explain variation in appendectomy and NOM rates.

All adult hospitalizations for appendicitis were tabulated from the 2019-2022 Nationwide Readmissions Database. Initial, exploratory analyses revealed that appendectomy rates were lower in not-for-profit (NFP) relative to for-profit (FP) hospitals. Bayesian logistic regression and Fairlie decomposition were employed to explain the bases for these differences.

There were 4394 NFP and 818 FP hospitals. When compared with FP facilities, NFP hospitals had a smaller proportion of appendicitis cases treated by appendectomy (82.9 ± 11.8 v. 89.7 ± 8.0) (mean ± SD) (Cohen's d: -0.70) and less than one-half the amount of charges $44,713 [30,217, 65,442] vs. $93,078 [64,171, 129,301] (median ± IQR) (Cohen's d > -0.7, medium effect size). When estimated from regression equations, the gap between NFP and FP hospital appendectomy rates was 7.5 %. Total charges explained almost all of the gap between NFP and FP hospital appendectomy rates (0.068/0.090 = 75 %) of the gap. The presence of complicated appendicitis and EGS volume reduced the gap by -0.013 (-0.013/0.090 = 14 %).

Appendectomy rates for the treatment of appendicitis were greater in FP hospitals with almost all the difference in the rates explained by much higher charges observed in FP hospitals. The potential for greater profit from appendectomy as compared with NOM of appendicitis may explain why appendectomy is more common in FP hospitals.