Health care costs after operative versus nonoperative appendicitis management utilizing an administrative claims...

Use of nonoperative management for uncomplicated appendicitis is increasing. We hypothesized that health care costs would be lower for patients who underwent appendectomy than for those with an in situ appendix over the year after initial diagnosis.

Using MarketScan, an all-payers claims insurance database, we extracted patients presenting to the emergency department with acute appendicitis and without perforation from 2017 to 2021, and either underwent appendectomy during index presentation or nonoperative treatment. We examined differences in the cost of the initial encounter and within one-year.

Of 26,469 patients presenting with uncomplicated appendicitis, 24,005 (90.6%) underwent appendectomy. The median cost of the index encounter was higher at $15,248 in the operative group compared with $5,753 in the nonoperative group (p < 0.001). However, the median cost of follow-up encounters in the nonoperative group was higher at $3,946 compared with $3,338 in the operative group (p = 0.003). For the 78 (3.1%) patients who were initially managed nonoperatively and subsequently underwent follow-up appendectomy, the median cost was an additional $16,348. Based on average costs, nonoperative management must therefore succeed 68% of the time to be less costly than operative management.

Nonoperative management of uncomplicated appendicitis was associated with higher costs for follow-up encounters and total costs of care that were 70% greater if they eventually underwent follow-up appendectomy. Based on average costs in our population, if nonoperative management failed more than 32% of the time, it became the more costly strategy. (J Trauma Acute Care Surg 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).

Therapeutic/Care Management; Level III.