L. A. Bliss1, C. J. Yang1, Z. Chau2, E. Witkowski2, S. Ng1, W. Al-Refaie3, J. F. Tseng1 1Beth Israel Deaconess Medical Center,Surgical Outcomes Analysis & Research,Boston, MA, USA 2University Of Massachusetts Medical School,Department Of Surgery,Worcester, MA, USA 3Georgetown University Medical Center,Department Of Surgery,Washington, DC, USA
Introduction: Elderly patients (65 years of age or older) may be at risk after routine surgical procedures given underlying co-morbidities, frailty, and decreased physiologic reserve. Research regarding readmissions in the elderly population following appendectomy for acute appendicitis is limited. This study examines rates, risk factors, and costs for readmission among elderly patients undergoing appendectomies for acute appendicitis.
Methods: The Healthcare Cost and Utilization Project (HCUP) Florida State Inpatient Database and State Emergency Department Database with HCUP supplemental files for revisit analysis were used to identify inpatient admissions between 2007 and 2011 for patients age 65 years or older who underwent appendectomy for acute appendicitis. Readmission was defined as emergency department (ED) visit or inpatient admission within 30 days of discharge. Demographic data included sex, age, Elixhauser co-morbidity score, and race. Index admission information included procedure, length of stay (LOS), and complications. Total costs were determined using HCUP Cost-to-Charge Ratio Files. Univariate and multivariate analysis performed by chi-square and logistic regression. For all, p-values <0.05 were considered statistically significant.
Results: Within this large, racially diverse state, 8,669 elderly patients underwent appendectomy for acute appendicitis from 2007 to 2011. Appendectomy median LOS was 3 days (interquartile range (IQR) 2-6 days) and median cost was $9,384 (IQR $7,211-$13,009). 12.94% experienced inpatient complications. 13.39% (1,161) were readmitted within 30 days, of whom 39.19% (455) experienced an ED visit only and 60.81% (706) underwent inpatient readmission. After adjustment, readmission was more likely among males (p=0.0147) discharged to skilled nursing or other facilities (p<0.0001) with 3 or more co-morbidities (p<0.0001) and with select inpatient complications. On the other hand, within-elderly age and prolonged LOS did not predict re-admission. Of those readmitted, 16.37% had more than one readmission and median total cost of care was $16,624 (IQR $11,419-$25,244).
Conclusion: Appendicitis is not uncommon in elderly patients, who are at risk for both ED visits and inpatient admissions after appendectomy. Readmissions are more common among those discharged to facilities or with select complications during index admission. The financial impact of readmission is significant. Identifying elderly at risk of post-operative readmission may offer significant cost and resource savings.