CAPS PaperCost analysis of nonoperative management of acute appendicitis in children

PurposeThe purpose of this study was to determine if nonoperative management of acute appendicitis in children is more cost effective than appendectomy.MethodsA retrospective review of children (6-17 years) with acute appendicitis treated nonoperatively (NOM) from May 2012 to May 2015 was compared to similar patients treated with laparoscopic appendectomy (OM) (IRB#107535). Inclusion criteria included symptoms ≤ 48 h, localized peritonitis, and ultrasound confirmation of acute appendicitis. Variables analyzed included failure rates, complications, length of stay (LOS), and cost analysis.Results26 NOM patients (30% female, mean age 12) and 26 OM patients (73% female, mean age 11) had similar median initial LOS (24.5 h (NOM) vs 16.5 h (OM), p = 0.076). Median total LOS was significantly longer in the NOM group (34.5 h (NOM) vs 17.5 (OM), p = 0.01). Median cost of appendectomy was $1416.14 (range $781.24-$2729.97). 9/26 (35%) NOM patients underwent appendectomy for recurrent appendicitis. 4/26 (15%) OM patients were readmitted (postoperative abscess (n = 2), Clostridium difficile colitis (n = 1), postoperative nausea/vomiting (n = 1)). Median initial hospital admission costs were significantly higher in the OM group ($3502.70 (OM) vs $1870.37 (NOM), p = 0.004)). However, median total hospital costs were similar for both groups ($3708.68 (OM) vs $2698.99 (NOM), p = 0.065)).ConclusionAlthough initial costs were significantly less in children with acute appendicitis managed nonoperatively, total costs were similar for both groups. The high failure rate of nonoperative management in this series contributed to the total increased cost in the NOM group.Level of evidence: 3b