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Complications and Cost of Transferring Pediatric Appendicitis
*Justin Lee1, Kevin Moriarty2
1St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA;2Baystate Children's Hospital, Tufts University School of Medicine, Springfield, MA

We sought to evaluate demographics and outcomes of pediatric appendicitis transfer cases.
Retrospective Cohort Analysis
Setting and Patients:
Pediatric appendicitis hospitalizations from 1997 to 2009 were selected from the Kids’ Inpatient Database.
Admission source was analyzed for either transferred from another hospital versus primary admission.
Main Outcome Measures:
Data analysis included demographics, hospital characteristics, complications, procedures, length of stay (LOS), and total hospital charges (THC).
A total of 4,359 transfer cases of pediatric appendicitis were identified. When comparing transfer cases to primary admission cases on univariate analysis, transfer cases were more likely younger children (Age <12 years old, OR 3.214, P<0.001), black or Hispanic (OR 1.424, P<0.001), with Medicaid (OR1.572, P<0.001), transferred over weekend (OR1.171, P<0.001), to large hospitals (1.151, P<0.001), located in urban areas (OR 1.473, P<0.001), On multivariate analysis, we identified that younger children (Age < 12 years old, OR 3.552, P<0.001) were more likely to be transferred to hospitals in urban areas (OR 1.485, P<0.001). Transfer cases were more likely to have complications of abscess or perforation (OR 2.129, P<0.001) requiring drainage procedures (OR 2.842, P<0.001), with a longer median LOS (3 days vs 2 days, P<0.001) and higher mean THC ($25,669 vs $17,326, P<0.001). No statistical differences were found in the rate of laparoscopic appendectomy (35.7% vs 35.6%, P=0.898).
Transfer cases of pediatric appendicitis are more likely to occur in children less than 12 years old being transferred to hospitals in urban locations. The increase in perforation and abscess formation requiring drainage procedures may be due to potential delay in treatment. Further studies are needed to analyze pediatric surgeon shortage and transfer patterns of rural hospitals.

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