Daniel Leberer1, John O Elliott2, Edward Dominguez3. 1. Department of Surgery, Colon and Rectal Surgery Fellowship, University at Buffalo State, Buffalo, NY, USA. Electronic address: dleberer@gmail.com. 2. OhioHealth Research Institute, Columbus, OH, USA. Electronic address: john.elliott@ohiohealth.com. 3. Department of General Surgery, OhioHealth Riverside Methodist Hospital, Columbus, OH, USA; Department of Medical Education, OhioHealth Riverside Methodist Hospital, Columbus, OH, USA. Electronic address: e34dominguez@yahoo.com.
Abstract
BACKGROUND: Recent healthcare policy changes have emphasized pay-for-performance. Previous studies have not examined outcome differences between primary presenting appendicitis patients and transferred patients. METHODS: A retrospective cohort design examined appendicitis patients between March 2011 and 2013. Patients < age 18, were scheduled for an elective appendectomy, who were pregnant or had an interval appendectomy were excluded. RESULTS: The transfer cohort (n = 59) had more comorbidities, more severe American Society of Anesthesiologists status, a higher rate of pre-operative abscess/rupture as well as higher rates of perforation, gangrene, intra-operative drain placement and open conversion versus primary presenting patients (n = 622). After statistical regression adjustment, a higher open conversion rate in the transfer cohort, OR = 3.48 (95%CI: 1.04-11.61) and higher total costs $672.47 (95%CI: $68.75-$1276.19) remained. CONCLUSIONS: Adjustments in clinical outcome/reimbursement metrics may be needed to address the complexity of transfers and the subsequent higher in-hospital costs on tertiary facilities. LEVEL OF EVIDENCE: IV.
BACKGROUND: Recent healthcare policy changes have emphasized pay-for-performance. Previous studies have not examined outcome differences between primary presenting appendicitispatients and transferred patients. METHODS: A retrospective cohort design examined appendicitispatients between March 2011 and 2013. Patients < age 18, were scheduled for an elective appendectomy, who were pregnant or had an interval appendectomy were excluded. RESULTS: The transfer cohort (n = 59) had more comorbidities, more severe American Society of Anesthesiologists status, a higher rate of pre-operative abscess/rupture as well as higher rates of perforation, gangrene, intra-operative drain placement and open conversion versus primary presenting patients (n = 622). After statistical regression adjustment, a higher open conversion rate in the transfer cohort, OR = 3.48 (95%CI: 1.04-11.61) and higher total costs $672.47 (95%CI: $68.75-$1276.19) remained. CONCLUSIONS: Adjustments in clinical outcome/reimbursement metrics may be needed to address the complexity of transfers and the subsequent higher in-hospital costs on tertiary facilities. LEVEL OF EVIDENCE: IV.
Authors: Jennifer L Philip; Dou-Yan Yang; Xing Wang; Sara Fernandes-Taylor; Bret M Hanlon; Jessica Schumacher; Megan C Saucke; Jeffrey Havlena; Heena P Santry; Angela M Ingraham Journal: Surgery Date: 2020-05-23 Impact factor: 3.982
Authors: Peter C Minneci; Erinn M Hade; Gregory A Metzger; Jacqueline M Saito; Grace Z Mak; Katherine J Deans Journal: JAMA Date: 2021-06-22 Impact factor: 56.272