title: Hospital cost analysis of a prospective, randomized trial of early vs interval appendectomy for perforated appendicitis in children.
abstract: BACKGROUND
  The methods of surgical care for children with perforated appendicitis are controversial. Some surgeons prefer early appendectomy; others prefer initial nonoperative management followed by interval appendectomy. Determining which of these two therapies is most cost-effective was the goal of this study.
  
  
  METHODS
  We conducted a prospective, randomized trial in children with a preoperative diagnosis of perforated appendicitis. Patients were randomized to early or interval appendectomy. Overall hospital costs were extracted from the hospital's internal cost accounting system and the two treatment groups were compared using an intention-to-treat analysis. Nonparametric data were reported as median ± standard deviation (or range) and compared using a Wilcoxon rank sum test.
  
  
  RESULTS
  One hundred thirty-one patients were randomized to either early (n = 64) or interval (n = 67) appendectomy. Hospital charges and costs were significantly lower in patients randomized to early appendectomy. Total median hospital costs were $17,450 (range $7,020 to $55,993) for patients treated with early appendectomy vs $22,518 (range $4,722 to $135,338) for those in the interval appendectomy group. Median hospital costs more than doubled in patients who experienced an adverse event ($15,245 vs $35,391, p < 0.0001). Unplanned readmissions also increased costs significantly and were more frequent in patients randomized to interval appendectomy.
  
  
  CONCLUSIONS
  In a prospective randomized trial, hospital charges and costs were significantly lower for early appendectomy when compared with interval appendectomy. The increased costs were related primarily to the significant increase in adverse events, including unplanned readmissions, seen in the interval appendectomy group.
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Adrianne L
authors.initials: AL
authors.lastname: Myers
authors.forename: Regan F
authors.initials: RF
authors.lastname: Williams
authors.forename: Kim
authors.initials: K
authors.lastname: Giles
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Waters
authors.forename: James W
authors.initials: JW
authors.lastname: Eubanks
authors.forename: S Douglas
authors.initials: SD
authors.lastname: Hixson
authors.forename: Eunice Y
authors.initials: EY
authors.lastname: Huang
authors.forename: Max R
authors.initials: MR
authors.lastname: Langham
authors.forename: Martin L
authors.initials: ML
authors.lastname: Blakely
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000191:economics* / Q000379:methods; D001064:Appendicitis / Q000191:economics / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D057194:Intention to Treat Analysis; D010359:Patient Readmission / Q000191:economics; D011183:Postoperative Complications / Q000191:economics; D011446:Prospective Studies; D013714:Tennessee; D013997:Time Factors; D016896:Treatment Outcome