Outcomes and costs of pediatric appendectomies at rural hospitals.

Adolescent Appendectomy / adverse effects Appendicitis / economics Child Child, Preschool Cohort Studies Databases, Factual Female Hospital Costs / statistics & numerical data Hospitals, Rural / statistics & numerical data Hospitals, Urban / statistics & numerical data Humans Infant Laparoscopy / adverse effects Length of Stay / statistics & numerical data Male Postoperative Complications / epidemiology Retrospective Studies Treatment Outcome
Appendicitis Costs Outcomes Pediatric Rural Urban

Journal

Journal of pediatric surgery
ISSN: 1531-5037
Titre abrégé: J Pediatr Surg
Pays: United States
ID NLM: 0052631

Informations de publication

Date de publication:
Jan 2019
Historique:
received: 21 09 2018
accepted: 01 10 2018
pubmed: 6 11 2018
medline: 5 3 2019
entrez: 4 11 2018
Statut: ppublish

Résumé

Despite policy efforts to support rural hospitals, little is known about the quality and safety of pediatric surgical care in geographically remote areas. Our aim was to determine the outcomes and costs of appendectomies at rural hospitals. The Kids' Inpatient Database (2003-2012) was queried for appendectomies in children <18 years at urban and rural hospitals. Outcomes (disease severity, laparoscopy, complications, length of stay (LOS), cost) were analyzed with bivariate and multivariable regression analysis. Rural hospitals performed 13.6% of appendectomies. On multivariable analysis, rural hospitals were associated with higher negative appendectomy rates (OR 1.49, 95% CI 1.39-1.60, p < 0.001), decreased appendiceal perforation rates (OR 0.86, 95% CI 0.83-0.89, p < 0.001), less laparoscopy use (OR 0.48, 95% CI 0.47-0.50, p < 0.001), higher complication rates (OR 1.29, 95% CI 1.19-1.39, p < 0.001), shorter LOS (IRR 0.90, 95% CI 0.89-0.91, p < 0.001), and slightly increased costs (exponentiated log$ 1.02, 95% CI 1.01-1.02, p < 0.001) CONCLUSIONS: Rural hospitals care for fewer patients with advanced appendicitis but are associated with higher negative appendectomy rates, lower laparoscopy use, and higher complication rates. Additional studies are needed to identify factors that drive this disparity to improve the quality of pediatric surgical care in rural settings. Treatment/Cost Study (Outcomes). Level III.

Sections du résumé

BACKGROUND/PURPOSE OBJECTIVE
Despite policy efforts to support rural hospitals, little is known about the quality and safety of pediatric surgical care in geographically remote areas. Our aim was to determine the outcomes and costs of appendectomies at rural hospitals.
METHODS METHODS
The Kids' Inpatient Database (2003-2012) was queried for appendectomies in children <18 years at urban and rural hospitals. Outcomes (disease severity, laparoscopy, complications, length of stay (LOS), cost) were analyzed with bivariate and multivariable regression analysis.
RESULTS RESULTS
Rural hospitals performed 13.6% of appendectomies. On multivariable analysis, rural hospitals were associated with higher negative appendectomy rates (OR 1.49, 95% CI 1.39-1.60, p < 0.001), decreased appendiceal perforation rates (OR 0.86, 95% CI 0.83-0.89, p < 0.001), less laparoscopy use (OR 0.48, 95% CI 0.47-0.50, p < 0.001), higher complication rates (OR 1.29, 95% CI 1.19-1.39, p < 0.001), shorter LOS (IRR 0.90, 95% CI 0.89-0.91, p < 0.001), and slightly increased costs (exponentiated log$ 1.02, 95% CI 1.01-1.02, p < 0.001) CONCLUSIONS: Rural hospitals care for fewer patients with advanced appendicitis but are associated with higher negative appendectomy rates, lower laparoscopy use, and higher complication rates. Additional studies are needed to identify factors that drive this disparity to improve the quality of pediatric surgical care in rural settings.
TYPE OF STUDY METHODS
Treatment/Cost Study (Outcomes).
LEVEL OF EVIDENCE METHODS
Level III.

Identifiants

DOI: 10.1016/j.jpedsurg.2018.10.018 PMID: 30389148
pubmed: 30389148
pii: S0022-3468(18)30636-5
doi: 10.1016/j.jpedsurg.2018.10.018
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

103-107

Informations de copyright

Copyright © 2018 Elsevier Inc. All rights reserved.

Auteurs

Cynthia M Tom (CM)

Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA 90502, USA.

Scott Friedlander (S)

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.

Rie Sakai-Bizmark (R)

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.

Shant Shekherdimian (S)

Division of Pediatric Surgery, UCLA, 10833 Le Conte Ave, Box 709818, Los Angeles, CA 90095, USA.

Howard Jen (H)

Division of Pediatric Surgery, UCLA, 10833 Le Conte Ave, Box 709818, Los Angeles, CA 90095, USA.

Daniel A DeUgarte (DA)

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; Division of Pediatric Surgery, UCLA, 10833 Le Conte Ave, Box 709818, Los Angeles, CA 90095, USA.

Steven L Lee (SL)

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; Division of Pediatric Surgery, UCLA, 10833 Le Conte Ave, Box 709818, Los Angeles, CA 90095, USA. Electronic address: StevenLee@Mednet.UCLA.edu.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adolescent › Outcomes and costs of pediatric appendectomies...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie digestive › Appendicectomie › Outcomes and costs of pediatric appendectomies...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Maladies du caecum › Appendicite › Outcomes and costs of pediatric appendectomies...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Outcomes and costs of pediatric appendectomies...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Enfant d'âge préscolaire › Outcomes and costs of pediatric appendectomies...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Outcomes and costs of pediatric appendectomies...
questionsmedicales.fr › Sciences de l'information › Mémorisation et recherche des informations › Bases de données comme sujet › Bases de données factuelles › Outcomes and costs of pediatric appendectomies...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Coûts des soins de santé › Coûts hospitaliers › Outcomes and costs of pediatric appendectomies...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Hôpitaux › Hôpitaux ruraux › Outcomes and costs of pediatric appendectomies...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Hôpitaux › Hôpitaux urbains › Outcomes and costs of pediatric appendectomies...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Outcomes and costs of pediatric appendectomies...
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Outcomes and costs of pediatric appendectomies...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Endoscopie › Laparoscopie › Outcomes and costs of pediatric appendectomies...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Durée du séjour › Outcomes and costs of pediatric appendectomies...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Outcomes and costs of pediatric appendectomies...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Outcomes and costs of pediatric appendectomies...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Outcomes and costs of pediatric appendectomies...