Misdiagnosing adult appendicitis: clinical, cost, and socioeconomic implications of negative appendectomy.
BACKGROUND
The aim of this study was to evaluate the clinical, financial, and socioeconomic factors associated with negative appendectomy (NA).


METHODS
Data were obtained from the California State Inpatient Database (2005 to 2011). Patients (≥18 years) who underwent nonincidental appendectomies (n = 180,958) were evaluated with multivariate regression analyses.


RESULTS
NA rates decreased from 4.5% in 2005 to 2.8% in 2011 (P < .01). Compared with patients with nonperforated appendicitis, NA was associated with longer length of stay, higher morbidity, and higher hospital costs. Multivariate regression demonstrated that African Americans, younger age (18 to 29 years), and females were predictors of NA. Hispanics and patients with public or no insurance were associated with a lower NA rate; however, perforation rates were higher.


CONCLUSIONS
NA was associated with higher cost, longer length of stay, and higher morbidity compared with nonperforated appendicitis. Lower NA rates but higher perforation rates in some populations suggest a delay in presentation. Further research is needed to understand these disparities and to improve quality of care among low-income minority patients.
Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA 90502, USA; Los Angeles Biomedical Research Institute, 1124 W Carson Street, Torrance, CA 90502, USA.
Kyle
K
Mock
Los Angeles Biomedical Research Institute, 1124 W Carson Street, Torrance, CA 90502, USA; Department of Pediatrics, Harbor-UCLA Medical Center, 1000 W Carson Street, Torrance, CA 90502, USA.
Yang
Y
Lu
Los Angeles Biomedical Research Institute, 1124 W Carson Street, Torrance, CA 90502, USA; Department of Pediatrics, Harbor-UCLA Medical Center, 1000 W Carson Street, Torrance, CA 90502, USA.
Scott
S
Friedlander
Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA 90502, USA; Los Angeles Biomedical Research Institute, 1124 W Carson Street, Torrance, CA 90502, USA.
Dennis Y
DY
Kim
Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA 90502, USA; Los Angeles Biomedical Research Institute, 1124 W Carson Street, Torrance, CA 90502, USA; Department of Pediatrics, Harbor-UCLA Medical Center, 1000 W Carson Street, Torrance, CA 90502, USA. Electronic address: slleemd@yahoo.com.
Steven L
SL
Lee
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001062:Appendectomy / Q000009:adverse effects* / Q000191:economics*; D001064:Appendicitis / Q000175:diagnosis* / Q000191:economics / Q000601:surgery*; D002140:California; D003951:Diagnostic Errors / Q000009:adverse effects* / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D019564:Unnecessary Procedures / Q000009:adverse effects / Q000191:economics; D055815:Young Adult
Appendicitis; Health care disparity; Hospital cost; Negative appendectomy