Back to 2017 Program

Objective: The goal of this study was to examine the influence of time to appendectomy (TTA) and operative duration (OD) on hospital cost as surrogate measures of timeliness and perioperative efficiency.
Design: Retrospective, multi-center cohort analysis. TTA (ED presentation to incision) and OD were obtained from the ACS NSQIP-Pediatric Appendectomy Pilot Database and merged with cost data from the Pediatric Health Information System Database.
Setting: 14 children’s hospitals (1/2013-12/2014)
Patients: Children with uncomplicated appendicitis (n=2,116)
Interventions: N/A
Main Outcome Measures: Multivariate regression was used to examine the influence of TTA and OD on hospital cost while adjusting for patient and hospital-level characteristics.
Results: Median hospital TTA and OD was 8.3 hours (IQR:6.1-9.2) and 37 minutes (IQR:33-43), respectively. Longer TTA was associated with higher total and room-associated costs, with the longest quartile associated with 23% higher total cost ($1,589/case,RR:1.23,CI:1.14-1.32,p=<0.001) and 53% higher room-associated cost ($906/case,RR:1.53,CI:1.35-1.74,p=<0.001) compared to the shortest quartile. Longer OD was the more significant contributor to total cost overall, with the longest quartile associated with 38% higher total cost ($2,512/case,RR:1.38,CI:1.27-1.5,p<0.001) and 27% higher OR-associated cost ($960/case,RR:1.27, CI:1.22-1.34, p<0.001) compared to the shortest quartile. Across all hospitals, the influence of TTA and OD on cost were found to be independent but potentiating effects (figure).
Conclusions: Increased TTA and OD were independently associated with increased hospital cost, with OD being the most significant driver of cost variation. Identification and dissemination of best practices from high-efficiency hospitals may provide high yield strategies for improving value in appendicitis care.