Prognostic Factors Associated with Clinical and Economic Outcomes of Appendectomies in Children: A Multilevel Analysis in a National Retrospective Cohort Study

Abstract

Background Acute appendicitis is the most common acute surgical abdominal pathology in children, and it has a large impact on morbidity and the costs incurred by health care systems. In low‐ and median‐income countries, national information on the clinical and economic outcomes associated with this surgery does not exist. This study aimed to identify and describe the clinical and economic outcomes for children undergoing appendectomy in Colombia's contributory system and to determine the prognostic factors associated with these outcomes. Methods A retrospective cohort study was conducted using administrative data from patients under 18 years of age who underwent an appendectomy between July 1, 2013, and September 30, 2015, in Colombia's contributory health system. Thirty‐day mortality rates, intensive care unit (ICU) admission rates, length of stay (LOS), readmission rates and median costs were estimated for the entire country by geographic region and insurer. The prognostic factors associated with these outcomes were identified using generalized multilevel mixed models. Results A total of 21,674 children were included. The 30‐day postoperative mortality rate was 0.06% [95% CI 0.02–0.9], the ICU admission rate was 8.00% [95% CI 7.63–8.36], the mean LOS was 2.48 days (SD 5.24), the readmission rate was 1.5% [95% CI 1.33–1.66] and the median cost for Colombia was 394 USD [p25–p75: 256–555]. The prognostic factors that were associated with the 30‐day ICU admission rate, LOS and readmission rate were the insurer, geographic region, age, occurrence of an appendectomy with peritoneal drainage, and certain comorbidities, such as cancer and neurological, respiratory and gastrointestinal illnesses. The prognostic factors associated with costs were those previously mentioned as well as the occurrence of a laparoscopic appendectomy. Conclusions In Colombia's contributory health system, large differences in clinical outcomes and the costs incurred by the system exist, and these differences are associated with the geographic region, the insurer, and some of the clinical characteristics of the children undergoing appendectomy.

Presurgical time and associated factors as predictors of acute perforated appendicitis: a prospective cohort study in a teaching pediatric hospital in Colombia

“…We found statistically significant differences between gender (predominantly male) and slightly younger age in the PA group [ 13 , 17 ]. 60.3% of our cohort had higher acute PA incidence than previously reported [ 7 ]. 11.7% of the patients came from rural areas, and 71.6% had low socioeconomic status.…”

“…Additionally, less developed omentum and less intra-abdominal fat facilitate the spread of peritonitis [ 4 – 6 ]. In worldwide literature, perforation frequency is higher in children than adults, with incidences between 15 and 50% [ 1 , 7 , 8 ]. Patient age is tied closely to the stage of acute appendicitis, so the youngest patients present with more advanced stages of the disease and are at greater risk of perforation, with a recent study showing a significant increase of perforation in relation to age as follows: 100% < 1 year; 100% 1–2 years; 83.3% 2–3 years; 71.4% 3–4 years; 78.6% 4–5 years and 47.3% - 5 years [ 9 ].…”

“…Patient age is tied closely to the stage of acute appendicitis, so the youngest patients present with more advanced stages of the disease and are at greater risk of perforation, with a recent study showing a significant increase of perforation in relation to age as follows: 100% < 1 year; 100% 1–2 years; 83.3% 2–3 years; 71.4% 3–4 years; 78.6% 4–5 years and 47.3% - 5 years [ 9 ]. In Colombia, a single national report shows 25.8% of appendectomies with peritoneal drainage [ 7 ]. At our institution, we found a 41.3% perforation rate in acute appendicitis in 2017.…”

“…Perforated appendicitis (PA) is associated with higher postoperative morbidity and mortality, prolonged hospital stays, and higher costs [ 1 , 7 , 10 ]. There are no comparative studies in our country [ 7 ].…”

Reconstruction with Free Flaps of Head and Neck Cancer Defects: A National Cohort Study

“…This study obtained information about all healthcare services consumed by individuals who were enrolled in the contributory system and reported by the insurers for the years 2013, 2014, 2015, and 2016. 13 , 14 The cohort was assembled using the FTT codes of SISPRO and the International Classification of Diseases-10 codes related with head and neck cancer.…”