title: A statewide analysis of specialized care for pediatric appendicitis.
abstract: BACKGROUND
  Appendicitis is the most common operative disease in children, yet few data exist to support specialized care for childhood appendicitis. We hypothesized that children treated with specialized care are younger, have more severe disease, and experience equal or better outcomes.
  
  
  METHODS
  Texas Blue Cross/Blue Shield claims data were reviewed for all children <18 years who underwent appendectomy for acute appendicitis from 2008 to 2012. Primary outcomes included adverse events, 30-day readmissions, and hospital duration of stay. χ(2), Fisher exact test, Student t test, and multivariate regression were performed.
  
  
  RESULTS
  Of the 3,886 pediatric appendectomies, 894 (23%) were performed by pediatric surgeons and 1,558 (40%) were performed in children's hospitals. Children treated by pediatric surgeons were younger, had more severe disease, underwent fewer computed tomography (CT) examinations, and were hospitalized longer (all P < .05). Similarly, children treated in children's hospitals were younger, underwent fewer CTs, were more likely to undergo laparoscopic appendectomy, and were hospitalized longer (all P < .05). Specialized care did not predict adverse events or 30-day readmissions; however, specialized care was associated with longer duration of stay (P < .01).
  
  
  CONCLUSIONS
  Privately insured children in Texas treated for appendicitis by pediatric surgeons or in children's hospitals were younger, had more severe disease, and were hospitalized longer but were less likely to undergo preoperative CT.
authors.affiliation: Departments of Surgical Oncology and Pediatric Surgery at the University of Texas MD Anderson Cancer Center and Medical School at Houston, Houston, TX.
authors.forename: Luke R
authors.initials: LR
authors.lastname: Putnam
authors.affiliation: Department of Management, Policy, and Community Health at the University of Texas School of Public Health, Houston, TX.
authors.forename: Linh K
authors.initials: LK
authors.lastname: Nguyen
authors.affiliation: Departments of Surgical Oncology and Pediatric Surgery at the University of Texas MD Anderson Cancer Center and Medical School at Houston, Houston, TX.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
authors.affiliation: Department of Management, Policy, and Community Health at the University of Texas School of Public Health, Houston, TX.
authors.forename: Luisa
authors.initials: L
authors.lastname: Franzini
authors.affiliation: Departments of Surgical Oncology and Pediatric Surgery at the University of Texas MD Anderson Cancer Center and Medical School at Houston, Houston, TX.
authors.forename: KuoJen
authors.initials: K
authors.lastname: Tsao
authors.affiliation: Departments of Surgical Oncology and Pediatric Surgery at the University of Texas MD Anderson Cancer Center and Medical School at Houston, Houston, TX. Electronic address: MAustin@mdanderson.org.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Austin
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D010372:Pediatrics; D012189:Retrospective Studies; D013043:Specialties, Surgical; D013781:Texas; D016896:Treatment Outcome