Cost and Late Hospital Care of Publicly Insured Children After Appendectomy

Kenneth A. Michelson*, Brian T. Bucher, Mark I. Neuman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Immediate complications of appendicitis are common, but the prevalence of long-term complications is uncertain. Methods: We studied all publicly-insured children in the US with uncomplicated or complicated appendicitis in 2018-2019 using administrative claims. The main outcome was late hospital care defined as hospitalization or abdominal procedure within 180 d of an appendicitis discharge, excluding interval appendectomies. Time to late hospital care was evaluated using Cox regression. We evaluated health-care expenditures arising from appendicitis episodes. Results: Among 95,942 children with appendicitis, 5727 (6.0%) had late hospital care, with 5062 requiring rehospitalization and 2012 (2.1%) surgery. The median time to late hospital care was 10 d (interquartile range 4-33). Age under 5 y (compared with >14 y, hazard ratio [HR] 1.88, 95% confidence interval [CI] 1.70-2.08), complex chronic conditions (HR 2.35, 95% CI 2.13-2.59), and complicated appendicitis (HR 2.81, 95% CI 2.67, 2.96) were each associated with time to late hospital care. Expenditures over 180 d were a median $6553 and $19,589 respectively in those requiring no late hospital care versus those requiring it (P < 0.001). Conclusions: Late hospital care is uncommon in pediatric appendicitis but is costly. Prevention efforts should be targeted to the youngest, most complex children, and those with complicated appendicitis at presentation.

Original languageEnglish (US)
Pages (from-to)41-46
Number of pages6
JournalJournal of Surgical Research
Volume297
DOIs
StatePublished - May 2024

Funding

The work was supported by AHRQ awards K08HS025776 (Bucher) and K08HS026503 (Michelson). Dr. Michelson also received support from the Boston Children's Hospital Office of Faculty Development. The AHRQ awards primarily supported salary, while the institutional award supported purchase of the data. The work was supported by AHRQ awards K08HS025776 (Bucher) and K08HS026503 (Michelson). Dr. Michelson also received support from the Boston Children's Hospital Office of Faculty Development. The AHRQ awards primarily supported salary, while the institutional award supported purchase of the data.

Keywords

  • Appendicitis
  • Complications
  • Costs
  • Pediatrics

ASJC Scopus subject areas

  • Surgery

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