Beyond perforation: Influence of peritoneal contamination on clinical severity and resource utilization in children with perforated appendicitis.
OBJECTIVE
The purpose of the study was to explore the relationship between the degree of peritoneal contamination and postoperative resource utilization in children with complicated appendicitis.


METHODS
Intraoperative findings were collected prospectively at a single children's hospital from 2012 to 2014. The degree of peritoneal contamination was categorized as either "localized" (confined to the right lower quadrant and pelvis) or "extensive" (extending to the liver). Imaging utilization, postoperative length of stay (pLOS), hospital cost, and readmission rates were compared between groups.


RESULTS
Of 88 patients with complicated appendicitis, 38% had extensive contamination. Preoperative characteristics were similar between groups. Patients with extensive contamination had higher rates of postoperative imaging (58.8% vs 27.7%, P<0.01), a 50% longer median pLOS (6days [IQR 4-9] vs 4days [IQR 2-5], P=0.003), a 30% higher median hospital cost ($17,663 [IQR $12,564-$23,697] vs $13,516 [IQR $10,546-$16,686], P=0.004), and a nearly four-fold higher readmission rate (20.6% vs 5.6%, P=0.04) compared to children with localized contamination.


CONCLUSIONS
Extensive peritoneal contamination is associated with significantly higher resource utilization compared to localized contamination in children with complicated appendicitis. These findings may have important severity-adjustment implications for reimbursement and readmission rate reporting for hospitals that serve populations where late presentation is common.
Boston Children's Hospital, Department of Surgery.
Christina
C
Feng
Boston Children's Hospital, Department of Surgery.
Seema
S
Anandalwar
Boston Children's Hospital, Department of Surgery.
Feroze
F
Sidhwa
Boston Children's Hospital, Department of Surgery.
Charity
C
Glass
Boston Children's Hospital, Department of Surgery.
Mahima
M
Karki
Boston Children's Hospital, Department of Surgery.
David
D
Zurakowski
Boston Children's Hospital, Department of Surgery. Electronic address: Shawn.Rangel@childrens.harvard.edu.
Shawn J
SJ
Rangel
D000293:Adolescent; D001062:Appendectomy / Q000009:adverse effects*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D017721:Hospital Costs; D006776:Hospitals, Pediatric / Q000191:economics*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D010359:Patient Readmission / Q000639:trends; D010538:Peritonitis / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*
Complicated appendicitis; Pediatric appendicitis; Peritoneal contamination