Management of acute appendicitis: the impact of CT scanning on the bottom line.
BACKGROUND
Acute appendicitis continues to be a common general surgical problem. Little is known about whether the contribution to margin has been affected by changes in technology.


METHODS
Patients undergoing appendectomy for acute appendicitis from June 2005 to May 2007 were evaluated for demographics, diagnostic and treatment alternatives, and outcomes. Financial outcomes were assessed. Efficiency, including admission to emergency department bed to incision (bed to knife time [BTK]), operative length, and hospital length of stay (LOS) were assessed.


RESULTS
During the 2 years of the study, there were no differences in demographics, insurance status, case length, diagnostic accuracy, pathology, LOS, or outcomes. Both laparoscopy and CT use increased between the 2 study years (odds ratio [OR]: 1.68, p = 0.06; 95% CI, 0.98-2.89 and OR: 1.83, p = 0.06, CI, 0.98-3.45, respectively). Mean BTK time increased by about 1 hour: 465 minutes versus 521 minutes (p = 0.032; 95% CI, 0.08-1.78) in univariate analysis. However, multivariate analysis demonstrated no difference in BTK time between years (p = 0.136). After controlling for gender, year of operation, and insurance status, obtaining a CT study added 3.5 hours to BTK time (p < 0.001; 95% CI, 2.41-4.45). Women had BTK times 55 minutes longer than men when controlling for similar covariates (p = 0.027; 95% CI, 0.11-1.74). Laparoscopy contributed to shorter mean LOS (-0.78 days, p = 0.04), and gangrenous appendicitis (1.80 days, p < 0.001) and complications (4.23 days, p < 0.001) increased LOS. Mean contribution to margin decreased from $6,347 to $4,295 (p = 0.068).


CONCLUSIONS
Increasing use of CT scanning in acute appendicitis increases cost of care, decreases contribution to margin, prolongs patient's stay in the emergency department, and delays time to operation.
Pritchett
Cedric V
CV
Department of Surgery, The Ohio State University and College of Public Health, Columbus, OH, USA.
Levinsky
Nick C
NC
Ha
Yoonhee P
YP
Dembe
Allard E
AE
Steinberg
Steven M
SM
D000293:Adolescent; D000328:Adult; D001062:Appendectomy / Q000191:economics*; D001064:Appendicitis / Q000175:diagnosis* / Q000191:economics / Q000601:surgery*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics*; D055815:Young Adult