Abstract
Background
Pediatric appendicitis accounts for a notable proportion of health care use and cost
in the United States. To identify opportunities for cost savings during pediatric
laparoscopic appendectomy, this study assessed whether surgeons' use of costlier disposable
supplies correlated with procedure duration and patient outcomes.
Methods
This retrospective cross-sectional study assessed laparoscopic appendectomy for uncomplicated
pediatric appendicitis at 2 tertiary-care academic hospitals. The cost of disposable
surgical supplies, procedure duration, and patient outcomes were obtained from medical
records. The correlation between average supply cost and procedure duration among
surgeons was assessed using Pearson’s correlation coefficient. Associations between
use of specific disposable supplies and supply cost or procedure duration were assessed
using Student’s t tests.
Results
A total of 380 laparoscopic appendectomies were performed by 11 surgeons. Mean normalized
supply cost varied between surgeons (range: 60.6%–151.1%) and was not correlated with
procedure duration (R = 0.2951, P = .378). The use of energy-based sealing devices (76.7% increase, P < .001), staplers (38.4% increase, P < .001), endoscopic specimen pouches (45.3% increase, P < .001), and disposable ports (43.6% increase, P < .001) increased overall disposable supply cost. None of the disposable supplies
in this analysis were associated with shorter procedures. Based on Medicaid reimbursement,
the interquartile range of supply cost was 9.2% and 6.0% of hospital revenue at each
site.
Conclusion
Surgeons varied in their use of disposable supplies for pediatric laparoscopic appendectomy,
but the cost of supplies used did not influence outcomes. Incentivizing more judicious
supply use may reduce costs related to pediatric appendicitis.
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Article info
Publication history
Published online: May 14, 2022
Accepted:
April 7,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
