A New Economic Benchmark for Surgical Treatment of Appendicitis

Firilas, Anthony M.; Higginbotham, Patti H.
August 1999
American Surgeon;Aug1999, Vol. 65 Issue 8, p769
Academic Journal
Cost reduction in the management of common surgical diseases such as appendicitis has become paramount for the survival of children's hospitals. We designed a clinical pathway to treat appendicitis with the goal of reducing cost and hospital length of stay (LOS) while maintaining quality of care. From September 1995 through December 1996, patients with nonperforated appendicitis (NPApp) and perforated appendicitis with peritonitis (PApp) were enrolled into a clinical pathway. NPApp patients were discharged when tolerating a regular diet. PApp patients were discharged if the following criteria were met: temperature < 38.5 Degrees C for 24 hours, WBC < 14,000 on postoperative day 3, tolerating diet, and transition to oral analgesics accomplished. Hospital LOS and actual hospital costs in pathway patients were compared with those of historic controls. Patients with appendicitis from the Pediatric Health Information Systems (PHIS) database, a consortium of 20 children's hospitals in the United States, served as concurrent controls. Hospital LOS and hospital charges in PHIS NPApp and PApp patients from our institution were compared with national PHIS database patients. Mean LOS and hospital costs for both NPApp and PApp pathway patients were significantly decreased compared with historic controls (P < 0.05). Mean LOS and hospital charges in our institution's PHIS NPApp and PApp patients were also significantly decreased compared with the national PHIS database (P < 0.05). Innovative approaches such as these are necessary for the survival of children's hospitals in an increasingly cost competitive healthcare market.


Related Articles

  • Kindliche Appendizitis. Gerstorfer, M.; Clauer, U.; Kistler, J.; Roder, J. // Der Chirurg;Nov2011, Vol. 82 Issue 11, p1008 

    Following the first description of open appendicectomy using a lateral incision in the right lower abdomen by McBurney in 1894, this intervention was considered to be the standard method for treatment of appendicitis for nearly 100 years. In 1983 the gynecologist Semm presented a new option for...

  • Gasless transumbilical laparoscopic-assisted appendectomy as a safe and cost-effective alternative surgical procedure for mild acute appendicitis. Munakata, Koji; Uemura, Mamoru; Shimizu, Junzo; Miyake, Masakazu; Hata, Taishi; Ikeda, Kimimasa; Dono, Keizo; Kitada, Masashi; Doki, Yuichiro; Mori, Masaki // Surgery Today;Mar2016, Vol. 46 Issue 3, p319 

    Purpose: Several reports have demonstrated the effectiveness and feasibility of single incisional transumbilical laparoscopic-assisted appendectomy (TULAA). We developed a modified TULAA technique, gasless-TULAA, which involves lifting the abdominal wall with a retractor, without...

  • Laparoscopic appendectomy significantly reduces length of stay for perforated appendicitis. Towfigh, S.; Chen, F.; Mason, R.; Katkhouda, N.; Chan, L.; Berne, T. // Surgical Endoscopy;Mar2006, Vol. 20 Issue 3, p495 

    Introduction: Though ruptured appendicitis is not a contraindication to laparoscopic appendectomy (LA), most surgeons have not embraced LA as the first-line approach to ruptured appendicitis. In fact, in 2002, the Cochrane Database Review concluded: 1) the clinical effects of LA are...

  • Laparoscopic Appendectomy Enables Military Personnel Return To Work Early. Demirbas, Sezai; Atay, Vedat; Api, Arman; Erenoglu, Cengiz; Yildiz, Mehmet // Internet Journal of Surgery;2007, Vol. 9 Issue 2, p3 

    Laparoscopic appendectomy (LA) involves some advantages such as less pain, short hospital stay and satisfactory exploration of the abdominal space since it was the first time described by Dr. Seem (1983) as an advanced laparoscopic procedure ([1]). LA appeared as the alternative approach against...

  • Training in Laparoscopic Appendectomy. Sweeney, Karl J.; Dillon, Mary; Johnston, Sean M.; Keane, Frank B.; Conlon, Kevin C. // World Journal of Surgery;Mar2006, Vol. 30 Issue 3, p358 

    Background: The role of laparoscopic appendectomy (LA) in surgical training is unclear. Although LA as a therapeutic modality is potentially superior to open surgery, it has failed to become established as standard in training hospitals. The aim of the present study was to evaluate the outcome...

  • Incisional Hernia after McBurney Incision: Retrospective Case-control Study of Risk Factors and Surgical Treatment. Beltr├ín, Marcelo A.; Cruces, Karina S. // World Journal of Surgery;Apr2008, Vol. 32 Issue 4, p596 

    Few reports have dealt with incisional hernias originating at a McBurney incision after appendectomy. The purpose of the present study was to identify risk factors for development of incisional hernia at a McBurney incision, and to describe our experience with the treatment of this kind of...

  • Time of presentation, time of operation, and unnecessary appendicectomy. McLean, A.D.; Stonebridge, P.A.; Bradbury, A.W.; Rainey, J.B.; Macleod, D.A.D. // BMJ: British Medical Journal (International Edition);1/30/93, Vol. 306 Issue 6873, p307 

    Investigates the relation between the time of presentation, time of operation, and unnecessary appendicectomy among patients undergoing surgery. Percentage of unnecessary operations performed within hours of presentation; Rate of unnecessary operations in patients; Findings on the relation...

  • A New Perspective in Appendicitis: Calculation of Half Time (T1/2) for Perforation. Redmond, J. Mark; Smith, Gardner W.; Wilasrusmee, Chumpon; Kittur, Dilip S. // American Surgeon;Jul2002, Vol. 68 Issue 7, p593 

    Appendicitis is generally a more serious disease in the elderly than in the young. In the former, perforation is seen commonly leading to the belief that the appendix perforates more readily and rapidly in the elderly. A competing view is that the appendix perforates relatively more frequently...

  • AMYAND'S HERNIA; A CASE REPORT. Iqbal, Muhammad Rafaih; Younis, Muhammad Umar; Saeed, Huma // Professional Medical Journal;2015, Vol. 22 Issue 8, p1101 

    Introduction: An appendix in an inguinal hernial sac is called as Amyand's Hernia. The appendix may or may not be inflamed. It is a rare occurrence in surgical practice. Case Presentation: A 23 years old male presented with the clinical diagnosis of strangulated right inguinal hernia. On...

  • Actinomyces Appendicitis: Diagnostic Dilemma--Malignancy or Infection? Ng, Nathaniel; Ng, Grace; Davis, Brian R.; Meier, Donald E. // American Surgeon;Jan2014, Vol. 80 Issue 1, pE33 

    This article describes a case study of abdominal actinomycosis. The patient was a 19-year-old woman who presented with a history of vague intermittent abdominal pain. Physical examination revealed tenderness to palpation in the right lower quadrant without rebound or guarding. Abdominal...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics