Cost analysis of nonoperative management of acute appendicitis in children.
OBJECTIVE
The purpose of this study was to determine if nonoperative management of acute appendicitis in children is more cost effective than appendectomy.


METHODS
A retrospective review of children (6-17years) with acute appendicitis treated nonoperatively (NOM) from May 2012 to May 2015 was compared to similar patients treated with laparoscopic appendectomy (OM) (IRB#107535). Inclusion criteria included symptoms ≤48h, localized peritonitis, and ultrasound confirmation of acute appendicitis. Variables analyzed included failure rates, complications, length of stay (LOS), and cost analysis.


RESULTS
26 NOM patients (30% female, mean age 12) and 26 OM patients (73% female, mean age 11) had similar median initial LOS (24.5h (NOM) vs 16.5h (OM), p=0.076). Median total LOS was significantly longer in the NOM group (34.5h (NOM) vs 17.5 (OM), p=0.01). Median cost of appendectomy was $1416.14 (range $781.24-$2729.97). 9/26 (35%) NOM patients underwent appendectomy for recurrent appendicitis. 4/26 (15%) OM patients were readmitted (postoperative abscess (n=2), Clostridium difficile colitis (n=1), postoperative nausea/vomiting (n=1)). Median initial hospital admission costs were significantly higher in the OM group ($3502.70 (OM) vs $1870.37 (NOM), p=0.004)). However, median total hospital costs were similar for both groups ($3708.68 (OM) vs $2698.99 (NOM), p=0.065)).


CONCLUSIONS
Although initial costs were significantly less in children with acute appendicitis managed nonoperatively, total costs were similar for both groups. The high failure rate of nonoperative management in this series contributed to the total increased cost in the NOM group.


METHODS
3b.
Division of General Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Martina
M
Mudri
Division of Pediatric Surgery, Children's Hospital, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Kamary
K
Coriolano
Division of Pediatric Surgery, Children's Hospital, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. Electronic address: Andreana.Butter@lhsc.on.ca.
Andreana
A
Bütter
D000208:Acute Disease; D000293:Adolescent; D000890:Anti-Infective Agents / Q000191:economics* / Q000627:therapeutic use; D001062:Appendectomy / Q000191:economics / Q000379:methods; D001064:Appendicitis / Q000188:drug therapy* / Q000191:economics / Q000601:surgery; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008131:London; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
D000890:Anti-Infective Agents
Appendicitis; Cost analysis; Nonoperative management; Pediatric