Institutional variations in the management of patients with acute appendicitis

Jennefer A. Kieran, Myriam J. Curet, Carol R. Schermer

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

The purpose of this study was to evaluate institutional differences in preoperative workup, operative approach, complications, and cost in patients with acute appendicitis. A retrospective chart review was performed of all adults operated on for acute appendicitis from June 1999 to November 2000 at the University of New Mexico Hospital (UNMH) and Stanford University Medical Center (SUMC). Variables compared included age, race, sex, duration of symptoms, type of symptoms, results of radiographic evaluation, time from emergency room to operating room, operative approach (open vs. laparoscopic), operative time, length of hospital stay, pathologic findings, and complications. Statistical analysis was performed by means of Fisher's exact test. A total of 154 appendectomies were performed for acute appendicitis at UNMH and 165 at SUMC. Statistically significant differences were found at UNMH vs. SUMC in time from emergency room to operating room (9.1 hours vs. 13.7 hours; P<0.001), operative approach (48% laparoscopic vs. 29% open; P<0.001), and negative appendectomy rate (13% vs. 4.8%; P<0.001). There were no differences in the perforation rate or other complications. Cost analysis showed that $56,744 more was spent at UNMH for the additional negative appendectomy operations, whereas $99,842 more was spent at SUMC for the additional CT scans. Institutional differences in the management of patients with acute appendicitis can result in significant differences in cost without clinically significant differences in outcome. The use of clinical examination and laparoscopy as diagnostic modalities instead of CT scanning resulted in a more cost-effective approach.

Original languageEnglish (US)
Pages (from-to)523-528
Number of pages6
JournalJournal of Gastrointestinal Surgery
Volume7
Issue number4
DOIs
StatePublished - May 2003
Externally publishedYes

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Appendicitis
Appendectomy
Costs and Cost Analysis
Operating Rooms
Hospital Emergency Service
Length of Stay
Operative Time
Laparoscopy

Keywords

  • Acute appendicitis
  • Computed tomography
  • Laparoscopy

ASJC Scopus subject areas

  • Surgery

Cite this

Institutional variations in the management of patients with acute appendicitis. / Kieran, Jennefer A.; Curet, Myriam J.; Schermer, Carol R.

In: Journal of Gastrointestinal Surgery, Vol. 7, No. 4, 05.2003, p. 523-528.

Research output: Contribution to journalArticle

Kieran, Jennefer A. ; Curet, Myriam J. ; Schermer, Carol R. / Institutional variations in the management of patients with acute appendicitis. In: Journal of Gastrointestinal Surgery. 2003 ; Vol. 7, No. 4. pp. 523-528.
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