Treatment of perforated appendicitis in children: what is the cost?
OBJECTIVE
We compared direct hospital costs and indirect costs to the family associated with immediate appendectomy or initial nonoperative management for perforated appendicitis in children.


METHODS
From June 2009 through May 2010, 61 prospectively identified families completed a cost diary, documenting the numbers of missed school days for the child and missed employment days for the adult caregiver(s) over the treatment course. Hospital costs were obtained from hospital financial databases. Mann-Whitney U tests and Fisher exact tests were used to compare outcome measures for each treatment strategy.


RESULTS
Patients treated by initial nonoperative management had a significantly longer median length of stay (9 days vs 7 days, P = .02) and a significantly greater median total hospital cost per patient ($31,349 vs $21,323, P = .01) when compared with those treated by immediate appendectomy. There was no significant difference in median number of missed school days (9 days vs 10 days, P = .23) or missed employment days for adult caregiver(s) (5 days vs 7 days, P = .18) between treatment strategies.


CONCLUSIONS
Patients with perforated appendicitis treated by initial nonoperative management had a greater length of stay and a significantly greater total hospital cost but were not burdened by significantly greater indirect costs compared with those treated by immediate appendectomy.
Department of Surgery, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
Kate V
KV
Dennett
Sarah
S
Tracy
Sharon
S
Fisher
Gisele
G
Charron
David
D
Zurakowski
Catherine E
CE
Calvert
Catherine
C
Chen
D018784:Abdominal Abscess / Q000188:drug therapy / Q000191:economics / Q000601:surgery; D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy / Q000191:economics* / Q000706:statistics & numerical data; D001064:Appendicitis / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D001900:Boston; D017028:Caregivers / Q000191:economics; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D019468:Disease Management; D004322:Drainage / Q000191:economics / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000191:economics*; D006786:Hospitals, Urban / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D011446:Prospective Studies
D000900:Anti-Bacterial Agents