The clinical land economic correlates of misdiagnosed appendicitis - Nationwide analysis

Background: Negative appendectomy (NA)-the nonincidental removal of a normal appendix-occurs commonly but the associated clinical- and system-level costs are not well studied. Hypothesis: The frequency of adverse clinical outcomes and associated financial burden of hospitalizations during which NA is performed is greater than previously recognized and varies widely among demographic groups. Design: Population-based, retrospective cohort study Setting: The 1997 Nationwide Inpatient Sample of the Health Care Utilization Project. Patients: All surveyed patients assigned International Classification of Diseases, Ninth Revision procedure codes for appendectomy but without an associated diagnosis of acute appendicitis. Main Outcome Measures: The age- and sex-stratified rates of NA, the incidence of associated infectious complications and case fatality, and the average length of stay and hospitalization charges during those admissions. Results: Nationwide, an estimated 261134 patients underwent nonincidental appendectomies in 1997, and 39 901 (15.3%) were negative for appendicitis. Women had a higher rate of NA as did patients younger than 5 years and older than 60 years. When compared with patients with appendicitis, NA was associated with a significantly longer length of stay (5.8 vs 3.6 days, P<.001), total charge-admission ($18780 vs $10584, P<.001), case fatality rate (1.5% vs 0.2%, P<.001), and rate of infectious complications (2.6% vs 1.8%, P<.001). An estimated $741.5 million in total hospital charges resulted from admissions in which a NA was performed. Conclusions: There are significant clinical and financial costs incurred by patients undergoing NA during the treatment of presumed appendicitis. These should be considered when evaluating system-level interventions to improve the management of appendicitis.