PURPOSE: 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. CONCLUSION: 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.
PURPOSE: 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. CONCLUSION: 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.
Authors: Katherine J Baxter; Heather L Short; Curtis D Travers; Kurt F Heiss; Mehul V Raval Journal: Pediatr Surg Int Date: 2018-10-13 Impact factor: 1.827
Authors: G Frongia; F Dostal; L Ziebell; N R Vuille-Dit-Bille; T Müller; J P Schenk; A Mehrabi; P Günther Journal: World J Surg Date: 2022-04-21 Impact factor: 3.282
Authors: Katherine J Baxter; Jennifer Hafling; Jennifer Sterner; Adarsh U Patel; Helen Giannopoulos; Kurt F Heiss; Mehul V Raval Journal: Pediatr Surg Int Date: 2018-05-04 Impact factor: 1.827
Authors: Martin Salö; Johanna Gudjonsdottir; Erik Omling; Lars Hagander; Pernilla Stenström Journal: JAMA Pediatr Date: 2018-10-01 Impact factor: 16.193
Authors: Seema P Anandalwar; Danielle B Cameron; Dionne A Graham; Patrice Melvin; Jonathan L Dunlap; Mark Kashtan; Matthew Hall; Jacqueline M Saito; Douglas C Barnhart; Brian D Kenney; Shawn J Rangel Journal: JAMA Surg Date: 2018-11-01 Impact factor: 14.766