Appendicitis in children in the managed care era

Area of Science:

• Pediatric Surgery
• Health Services Research
• Health Economics

Background:

• Acute appendicitis is a common pediatric surgical emergency.
• Concerns exist that managed care may delay surgical referrals, increasing morbidity and mortality.
• This study investigates the impact of managed care on pediatric appendicitis outcomes.

Purpose of the Study:

• To compare outcomes of pediatric acute appendicitis between managed care and indemnity insurance patients.
• To assess if managed care influences the incidence of late appendicitis.
• To evaluate complication rates, hospital stay, and costs associated with different insurance plans.

Main Methods:

• Retrospective chart review of pediatric appendectomy patients from January 1990 to March 1995.
• Classification of cases as 'late appendicitis' if the appendix was gangrenous or perforated.
• Comparison of outcomes between patients with traditional indemnity insurance (Group I) and a managed care plan (Group II).

Main Results:

• Late appendicitis occurred less frequently in the managed care group (21.6%) compared to the indemnity group (42.9%).
• Managed care patients experienced lower rates of major complications (1.4% vs. 3.6%) and overall complications (2.7% vs. 7.1%).
• Managed care was associated with shorter hospital stays (2.6 vs. 4.5 days) and lower average hospital charges ($6,507 vs. $8,754).

Conclusions:

• Managed care plans did not adversely affect outcomes for children with acute appendicitis.
• Managed care was associated with a reduced incidence of late appendicitis, fewer complications, and lower healthcare costs.
• The findings suggest managed care can provide quality care for pediatric appendicitis while reducing costs, without evidence of delayed surgical referral.