Abstracts
2002 Digestive Disease Week

# 108247 Abstract ID: 108247 Geographic Differences in the Management of Patients with Acute Appendicitis
Jennefer Kieran, Myriam Curet, Albuquerque, NM; Stanford, CA

Objective: The purpose of this study was to evaluate geographic differences in pre-operative work-up, operative approach, complications and cost in patients with acute appendicitis. Methods: A retrospective chart review was performed of all adults operated on for acute appendicitis from 6/99 to 11/00 at the University of New Mexico (UNM) and at Stanford Medical Center (SUMC). Variables compared included age, race, sex, duration of symptoms, type of symptoms, radiographic evaluation, time from emergency room (ER) to operating room (OR), operative approach (open vs laparoscopic), length of operation, hospital stay, pathology and complications. Statistical analysis was performed with Fisher's exact test. Results: 154 appendectomies were performed for acute appendicitis at UNM, and 165 at SUMC during this time period. Statistically significant differences between UNM and SUMC data were found in time from initial presentation in ER to entrance into OR (9.1 hours vs. 13.7 hours, p<0.001), use of pre-operative computed tomographic (CT) scan (5.2% vs. 61.8%, p<0.001), operative approach (48% laparoscopic vs 29% p<0.001) and negative appendectomy rate (12.3% vs. 4.8% p<0.001). There were no differences in the perforation rate or other complications. Cost analysis revealed ,907 more was spent at UNM for the additional negative appendectomy operations compared to SUMC, while ,842 more was spent at SUMC for the additional CT scans compared to UNM. Conclusions: Geographic differences in the management of patients with acute appendicitis can result in significant differences in cost. In this study, the use of routine preoperative CT scan decreased negative appendectomy rate, but increased the length of time from ER to OR and increased overall cost. The use of clinical exam and laparoscopy as diagnostic modalities instead of CT scanning resulted in a more cost-effective approach.