Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals.
OBJECTIVE
To improve clinical results and resource utilization in the care of appendicitis in children, the authors examined the current practice and outcomes of 30 pediatric hospitals.


METHODS
The Pediatric Health Information System (PHIS) database consists of comparative data from 30 free-standing Children's hospitals. The study population of 3,393 children was derived from the database by selecting the "Diagnosis Related Group Code" for appendicitis (APRDRGv12 164), ages 0 to 17 years, using discharges between October 1, 1999 and September 30, 2000. Data are expressed as the range and median for individual hospital outcomes.


RESULTS
The nonpositive appendectomy rate ranged from 0 to 17% at the 30 hospitals (median, 2.6%). Ruptured appendicitis varied from 20% to 76% (median, 36.5%). The median length of stay (LOS) for nonruptured appendicitis was 2 days (range, 1.4 to 3.1 days), ruptured appendicitis varied from 4.4 to 11 days (median, 6 days). The median readmission rate within 14 days was 4.3% (0 to 10%). Laparoscopic appendectomy varied from 0 to 95% in the 30 hospitals (mean, 31%) The LOS did not vary significantly in laparoscopic versus open for nonruptured (2.3 v 2.0 days) or ruptured appendicitis (5.5 v 6.2 days). Days on antibiotics for ruptured appendicitis ranged from 4.6 to 7.9 days (median, 5.9 days) Children receiving any study varied from 18% to 89% (median, 69%). Ultrasound scan and computed tomography (CT) were comparable in both nonruptured (13% ultrasound scan v 14%) and ruptured appendicitis (14% ultrasound scan v 21% CT).


CONCLUSIONS
Significant variability in practice patterns and resource utilization exists in the management of acute appendicitis in pediatric hospitals. Clinical outcomes could be improved by collaborative initiatives to adopt evidence-based best practices.
Newman
Kurt
K
Department of Surgery, Children's National Medical Center and George Washington University School of Medicine, Washington, DC, USA.
Ponsky
Todd
T
Kittle
Kory
K
Dyk
Lorna
L
Throop
Cheri
C
Gieseker
Karen
K
Sills
Marion
M
Gilbert
James
J
D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy / Q000191:economics / Q000706:statistics & numerical data; D001064:Appendicitis / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D016527:Drug Costs; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D017721:Hospital Costs; D006776:Hospitals, Pediatric / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012422:Rupture, Spontaneous; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents