S. C. Fallon1, W. Zhang1, M. E. Lopez1, M. L. Brandt1, M. E. Kim1, J. R. Rodriguez1, M. V. Mazziotti1, D. E. Wesson1, J. G. Nuchtern1, E. S. Kim1 1Baylor College Of Medicine,Division Of Pediatric Surgery,Houston, TX, USA
Introduction:
Previous literature has shown that decreasing variation in medical care often leads to improved value by optimizing outcomes and decreasing cost. The purpose of this study was to determine variation between individual surgeons caring for children with appendicitis in a large, tertiary children’s hospital.
Methods:
The records of all patients who underwent appendectomy during 2012 were retrospectively reviewed. Since 2011, patients in our institution have been managed using a standardized perioperative protocol, with >80% adherence to the protocol. The primary outcome evaluated was variable direct cost of the patient’s initial hospitalization. Secondary outcomes included operating time, intra-abdominal abscess (IAA) rate, and LOS. Results were stratified by surgeon, and by simple and complex disease. Final diagnosis was based on intra-operative findings. Linear, logistic, and Poisson regression models, adjusting for patient age, gender, and simple vs. complex appendicitis, were used to analyze the differences between surgeons with respect to these outcomes.
Results:
1,089 appendectomies were performed by 15 surgeons. The average number of cases per surgeon was 71.8(+5.5). There were significant differences between surgeons for operative time (p=0.001), cost of treatment (p=0.001), and LOS (p=0.005) for simple appendicitis. For complex appendicitis, there were significant differences between surgeons for operative time (p=0.001), cost of treatment (p=0.045), and IAA rate (p=0.005), but not LOS (p=0.979). (Figure 1)
Conclusion:
Significant differences in operating time, cost, LOS, and IAA rates in pediatric appendicitis exist between surgeons at a single, high volume, tertiary hospital despite the use of a standardized pre and post-operative evidence-based protocol. Future study to identify factors leading to these differences may allow further improvement in outcome while decreasing the cost of care.
