In-hospital Delay of Appendectomy in Acute, Complicated Appendicitis

Bolmers, Matthijs D M; Jonge, Jeroen de; Bom, Wouter J; Rossem, Charles C. van; Geloven, A. A. W. van; Bemelman, Willem A.; Acker, Gijs Jd Van; Akkermans, B.; Akkersdijk, G. J. M.; Algie, G. D.; Allema, Jan Hein; Andeweg, Caroline S.; Appeldoorn, N.; Baal, J. G. van; Bakker, Chantal M. den; Bartels, Stephan; Berg, C. van den; Boekestijn, Bas; Boer, Frank C. den; Boerma, D.; Boom, Anne Loes van den; Boute, M. C.; Bouwense, Stefan; Bransen, Jeroen; Brussel, F. A. van; Busch, Olivier R.; Castro, Susana; Cense, Huib A.; Croese, C.; Dalen, Thijs van; Dawson, I.; Dessel, Els Van; Dettmers, R.; Dhar, N.; Dohmen, F. Y.; Dongen, K. W. van; Duijvendijk, Peter van; Dulfer, R. R.; Dwars, Boudewijn J.; Eerenberg, J. P.; Elst, Maarten van der; Ende, E. van den; Fassaert, Leonie M.M.; Fikkers, J. T.; Foppen, J. W.; Furnee, E. J.; Garssen, F. P.; Gerhards, M. F.; Goor, Harry van; Graaf, J. S. de; Graat, Leon J.; Grootr, J.; Ham, Arie C. van der; Hamming, J. F.; Hamminga, J. T.; Harst, Erwin van der; Heemskerk, Jeroen; Heijne, Anders von; Heikens, Joost T.; Heineman, Erik; Hertogs, R.; Heurn, Ernst van; Hil, L. C. van den; Hooftwijk, A. G.; Hulsker, Caroline C. C.; Hunen, D. R.; Ibelings, M. S.; Klaase, Joost M.; Klicks, R.; Knaapen, L.; Kortekaas, R. T.; Kruyt, Flip M.; Kwant, S.; Lases, S. S.; Lettinga, T.; Loupatty, A.; Matthijsen, Robert A.; Minnee, Robert C.; Mirck, B.; Mitalas, Litza E.; Moes, Dirk Jan A R; Moorman, A. M.; Nieuwenhuijs, Vincent B.; Nieuwenhuizen, G. A.; Nijk, P. D.; Omloo, Jikke M.T.; Ottenhof, A. G.; Palamba, H.W.; Peet, Donald L. van der; Pereboom, Ilona T. A.; Plaisier, P. W.; Ploeg, A. P. van der; Raber, Marco; Reijen, M. M.; Rijna, Herman; Rosman, Camiel; Roumen, R.M.H.; Scmitz, R. F.; Velden, Arjan P. Schouten van der; Scheurs, W. H.; Sigterman, T. A.; Smeets, H.J.; Sonnevled, D. J.; Sosef, Meindert N.; Spoor, Simon; Stassen, Laurents P. S.; Steensel, Leendert van; Stortelder, E.; Straatman, Jennifer; Susante, H. J. van; Hoog, D. E. Suykerbuyk de; Scheltinga, Catharien Terwisscha van; Toorenvliet, Boudewijn R.; Verbeek, P. C. M.; Verseveld, M.; Volders, José H.; Vriens, Menno R.; Vriens, P.W.H.E.; Vrouenraets, B. C.; Wall, Bryan J. M. van de; Wegdam, Johannes A.; Westerduin, E.; Wever, Jan J.; Wijfels, N. A.; Wijnhoven, Bas P. L.; Winkel, Tamara A.; Zee, David C. van der; Zeillemaker, Anneke M.; Zietse, C.

doi:10.1007/s11605-021-05220-w

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…This estimate includes perforated appendicitis, as well as any 30-day revisits to give a more realistic cost comparison because patients present with perforated appendicitis for many reasons other than delayed diagnosis. 29 , 30 , 31 Appendicitis is diagnosed for 292 297 patients annually in the US. 32 A 2.7% rate of delayed diagnosis will impact 7892 patients annually and, given the mean marginal cost difference is $2712.45, this leads to $21 406 655 of preventable cost from poor diagnostic quality every single year.…”

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

“…This study sought to quantify the differences in appendicitis hospital care costs associated with delayed appendicitis diagnosis. This estimate includes perforated appendicitis, as well as any 30-day revisits to give a more realistic cost comparison because patients present with perforated appendicitis for many reasons other than delayed diagnosis . Appendicitis is diagnosed for 292 297 patients annually in the US .…”

Section: Discussionmentioning

confidence: 99%

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Appendicitis Hospitalization Care Costs Among Patients With Delayed Diagnosis of Appendicitis

Kulasekere,

Royan,

Shan

et al. 2024

JAMA Netw Open

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ImportanceDelayed appendicitis diagnosis is associated with worse outcomes. Appendicitis hospital care costs associated with delayed diagnosis are unknown.ObjectiveTo determine whether delayed appendicitis diagnosis was associated with increased appendicitis hospital care costs.Design, Setting, and ParticipantsThis cohort study used data from patients receiving an appendectomy aged 18 to 64 years in 5 states (Florida, Maryland, Massachusetts, New York, Wisconsin) that were captured in the Healthcare Cost and Utilization Project State Inpatient and Emergency Department databases for the years 2016 and 2017 with no additional follow-up. Data were analyzed January through April 2023.ExposuresDelayed diagnosis was defined as a previous emergency department or inpatient hospital encounter with an abdominal diagnosis other than appendicitis, and no intervention 7 days prior to appendectomy encounter.Main Outcomes and MeasuresThe main outcome was appendicitis hospital care costs. This was calculated from aggregated charges of encounters 7 days prior to appendectomy, the appendectomy encounter, and 30 days postoperatively. Cost-to-charge ratios were applied to charges to obtain costs, which were then adjusted for wage index, inflation to 2022 US dollar, and with extreme outliers winsorized. A multivariable Poisson regression estimated appendicitis hospital care costs associated with a delayed diagnosis while controlling for age, sex, race and ethnicity, insurance status, care discontinuity, income quartile, hospital size, teaching status, medical school affiliation, percentage of Black and Hispanic patient discharges, core-based statistical area, and state.ResultsThere were 76 183 patients (38 939 female [51.1%]; 2192 Asian or Pacific Islander [2.9%], 14 132 Hispanic [18.5%], 8195 non-Hispanic Black [10.8%], 46 949 non-Hispanic White [61.6%]) underwent appendectomy, and 2045 (2.7%) had a delayed diagnosis. Delayed diagnosis patients had median (IQR) unadjusted cost of $11 099 ($6752-$17 740) compared with $9177 ($5575-$14 481) for nondelayed (P &lt; .001). Patients with delayed diagnosis had 1.23 times (95% CI, 1.16-1.28 times) adjusted increased appendicitis hospital care costs. The mean marginal cost of delayed diagnosis was $2712 (95% CI, $2083-$3342). Even controlling for delayed diagnosis, non-Hispanic Black patients had 1.22 times (95% CI, 1.17-1.28 times) the adjusted increased appendicitis hospital care costs compared with non-Hispanic White patients.Conclusions and RelevanceIn this cohort study, delayed diagnosis of appendicitis was associated with increased hospital care costs.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Appendicitis Hospitalization Care Costs Among Patients With Delayed Diagnosis of Appendicitis

Kulasekere,

Royan,

Shan

et al. 2024

JAMA Netw Open

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“…Patients with true complicated appendicitis require urgent appendectomy to reduce the risk of postoperative complications. 31 External validation did not find the original SAS to be sufficiently accurate in excluding complicated appendicitis. Therefore, the SAS 2.0 was developed to accurately calculate an individual patient's probability of having complicated appendicitis based on clinical, biochemical, and imaging findings among adults with acute appendicitis.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of the Scoring System of Appendicitis Severity 2.0

Scheijmans,

Bom,

Ghori

et al. 2024

JAMA Surg

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ImportanceWhen considering nonoperative treatment in a patient with acute appendicitis, it is crucial to accurately rule out complicated appendicitis. The Atema score, also referred to as the Scoring System of Appendicitis Severity (SAS), has been designed to differentiate between uncomplicated and complicated appendicitis but has not been prospectively externally validated.ObjectiveTo externally validate the SAS and, in case of failure, to develop an improved SAS (2.0) for estimating the probability of complicated appendicitis.Design, Setting, and ParticipantsThis prospective study included adult patients who underwent operations for suspected acute appendicitis at 11 hospitals in the Netherlands between January 2020 and August 2021.Main Outcomes and MeasuresAppendicitis severity was predicted according to the SAS in 795 patients and its sensitivity and negative predictive value (NPV) for complicated appendicitis were calculated. Since the predefined targets of 95% for both were not met, the SAS 2.0 was developed using the same cohort. This clinical prediction model was developed with multivariable regression using clinical, biochemical, and imaging findings. The SAS 2.0 was externally validated in a temporal validation cohort consisting of 565 patients.ResultsIn total, 1360 patients were included, 463 of whom (34.5%) had complicated appendicitis. Validation of the SAS resulted in a sensitivity of 83.6% (95% CI, 78.8-87.6) and an NPV of 85.0% (95% CI, 80.6-88.8), meaning that the predefined targets were not achieved. Therefore, the SAS 2.0 was developed, internally validated (C statistic, 0.87; 95% CI, 0.84-0.89), and subsequently externally validated (C statistic, 0.86; 95% CI, 0.82-0.89). The SAS 2.0 was designed to calculate a patient’s individual probability of having complicated appendicitis along with a 95% CI.Conclusions and RelevanceIn this study, external validation of the SAS fell short in accurately distinguishing complicated from uncomplicated appendicitis. The newly developed and externally validated SAS 2.0 was able to assess an individual patient’s probability of having complicated appendicitis with high accuracy in patients with acute appendicitis. Use of this patient-specific risk assessment tool can be helpful when considering and discussing nonoperative treatment of acute appendicitis with patients.

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“…Another recent study has shown that short deferral of appendectomy does not increase the risk of appendiceal perforation, but may be associated with a slightly increased risk of surgical site infections [ 25 , 26 ]. In contrast to patients with simple appendicitis, delaying surgery for more than eight hours in patients with complicated acute appendicitis is associated with a higher risk of postoperative complications [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Daytime Versus Nighttime Laparoscopic Appendectomy in Children

et al. 2023

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Aim of the study: To evaluate the clinical outcomes and complication rate of laparoscopic appendectomy in children operated on during the daytime versus nighttime. Methods: A total of 303 children who underwent laparoscopic appendectomy for acute appendicitis between 1 January 2020 and 31 December 2022 were enrolled in this retrospective study. The patients were divided into two study groups. The first group consisted of the patients who underwent laparoscopic appendectomy during the day shift from 07:00–21:00 (n = 171), while the patients in the second group underwent laparoscopic appendectomy during the night shift from 21:00–07:00 (n = 132). The groups were compared for baseline clinical and laboratory data, treatment outcomes, and complications. The Mann–Whitney U test was used to compare continuous variables, while the Chi-square test was used to compare categorical variables. A two-sided Fisher’s exact test was used when the frequency of events in a certain cell was low. All p values less than 0.05 were considered significant. Results: The proportion of complicated appendicitis was almost the same in both patient groups (n = 63, 36.8% vs. n = 49, 37.1%, p = 0.960). Out of the total number of patients presenting during the daytime and nighttime, 11 (6.4%) and 10 (7.6%) developed a postoperative complication, respectively (p = 0.697). Additionally, rates of readmission (n = 5 (2.9%) vs. n = 2 (1.5%); p = 0.703), redo-surgery (n = 3 (1.7%) vs. n = 0; p = 0.260), conversion to open surgery (n = 0 vs. n = 1 (0.8%); p = 0.435) and length of hospital stay (n = 3 (IQR 1, 5) vs. n = 3 (IQR 2, 5); p = 0.368) did not differ significantly between daytime and nighttime appendectomies. The duration of the surgery was significantly shorter in patients presenting during the day than in those presenting at night (26 min (IQR 22, 40) vs. 37 min (31, 46); p < 0.001). Conclusions: Different shift times did not affect the treatment outcomes or complication rates for children receiving laparoscopic appendectomy.

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In-hospital Delay of Appendectomy in Acute, Complicated Appendicitis

Cited by 7 publications

References 15 publications

Appendicitis Hospitalization Care Costs Among Patients With Delayed Diagnosis of Appendicitis

Appendicitis Hospitalization Care Costs Among Patients With Delayed Diagnosis of Appendicitis

Development and Validation of the Scoring System of Appendicitis Severity 2.0

Clinical Outcomes of Daytime Versus Nighttime Laparoscopic Appendectomy in Children

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