Assessing outcomes and costs of appendectomies performed at rural hospitals

Cynthia M Tom; Erin C Howell; Roy P Won; Scott Friedlander; Rie Sakai-Bizmark; Christian de Virgilio; Steven L Lee

doi:10.1016/j.amjsurg.2018.10.038

Assessing outcomes and costs of appendectomies performed at rural hospitals

Am J Surg. 2019 Jun;217(6):1102-1106. doi: 10.1016/j.amjsurg.2018.10.038. Epub 2018 Oct 28.

Authors

Cynthia M Tom¹, Erin C Howell¹, Roy P Won¹, Scott Friedlander², Rie Sakai-Bizmark², Christian de Virgilio³, Steven L Lee⁴

Affiliations

¹ Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA, 90502, USA.
² Department of Pediatrics, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA, 90502, USA; Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA, 90502, USA.
³ Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA, 90502, USA; Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA, 90502, USA.
⁴ Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA, 90502, USA; Department of Pediatrics, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA, 90502, USA; Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA, 90502, USA. Electronic address: StevenLee@Mednet.UCLA.edu.

PMID: 30389118
DOI: 10.1016/j.amjsurg.2018.10.038

Abstract

Background: The purpose of our study was to assess the outcomes and costs of appendectomies performed at rural and urban hospitals.

Methods: The National Inpatient Sample (2001-2012) was queried for appendectomies at urban and rural hospitals. Outcomes (disease severity, laparoscopy, complications, length of stay (LOS), and cost) were analyzed.

Results: Rural patients were more likely to be older, male, white, and have Medicaid or no insurance. Rural hospitals were associated with higher negative appendectomy rates (OR = 1.26,95%CI = 1.18-1.34,p < 0.01), less laparoscopy use (OR = 0.65,95%CI = 0.58-0.72,p < 0.01), and slightly shorter LOS (OR = 0.98,95%CI = 0.97-0.99,p < 0.01). There was no consistent association with perforated appendicitis and no difference in complications or costs after adjusting for hospital volume. Yearly trends showed a significant increase in the cases utilizing laparoscopy each year at rural hospitals.

Conclusions: Rural appendectomies are associated with increased negative appendectomy rates and less laparoscopy use with no difference in complications or costs compared to urban hospitals.

Keywords: Costs; Laparoscopic appendectomy; Outcomes; Rural; Urban.

Publication types

Comparative Study

MeSH terms

Adult
Aged
Appendectomy / economics*
Appendicitis / economics
Appendicitis / surgery*
Databases, Factual
Female
Hospital Costs / statistics & numerical data*
Hospitals, Rural / economics*
Hospitals, Rural / statistics & numerical data
Hospitals, Urban / economics*
Hospitals, Urban / statistics & numerical data
Humans
Laparoscopy / economics
Laparoscopy / statistics & numerical data
Length of Stay / economics
Length of Stay / statistics & numerical data
Male
Middle Aged
Postoperative Complications / economics
Postoperative Complications / epidemiology
Retrospective Studies
Severity of Illness Index
Treatment Outcome
United States