R. P. Won1, S. Friedlander1, Y. Lu1, S. L. Lee1 1Harbor-UCLA Medical Center,Surgery And Pediatrics,Torrance, CA, USA
Introduction:
The study of regional variations in costs and outcomes of care has been used to identify areas of savings for several diseases and conditions. This study investigates similar potential regional differences in the cost and outcomes of adult appendicitis. We hypothesized that there would be no difference in rates of perforation, morbidity, length of stay (LOS), and cost among different regions of the US.
Methods:
Data were obtained from the California (CA), New York (NY), and Florida (FL) State Inpatient Databases spanning 2005-2011. Patients between the ages of 18-70 who underwent non-incidental appendectomies were evaluated with hierarchical and multivariate negative binomial regression analyses. Our primary outcomes included perforation, negative appendectomy, morbidity, hospital cost, and LOS.
Results:
There were 371,354 appendectomies performed between 2005-2011 in CA, NY, FL. The univariate analysis is summarized in the table. Multi-variate analysis confirmed the differences between states. CA had a higher rate of perforation compared to NY (p<0.01). CA also had a higher rate of negative appendectomies compared to both NY and FL (p<0.01). Morbidity was lower in NY compared to CA and FL (p<0.01). The LOS was lowest in CA (p<0.01), despite having the highest median cost per patient when compared to NY and FL (p<0.01)
Conclusion:
Significant regional differences exist with the presentation, outcomes, and costs associated with acute appendicitis. A better understanding of these differences may result in significant cost savings.
