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VALUE ASSESSMENT BY SCORE CARDS SURROGATES FOR APPENDECTOMIES, INCLUDING PRELIMINARY RESULTS OF A RANDOMIZED CONTROL TRIAL ON PERFORATED APPENDICITIS, AT A HEALTH NETWORK OVER 11 YEARS.
Michael Abdelmasseh, Araceli D. Cuaranta*, Arslan Iqbal, Juan Hernandez-Pelcastre, Jeremy Eckels, Tania Nguyen, Nicholas Tate, Chase Gillispie, Errington C. Thompson, Robert Finley, Barbara Payne, Todd H. Davies, Cierra King, Grace Montgomery, Jonathan Willis, Vineela Kadiyala, Juan Sanabria
Marshall University Joan C Edwards School of Medicine, Huntington, WV

BACKGROUND: Last year, 250,000 appendectomies were performed in the United States with an increased risk for postoperative complications in perforated cases. We aim to assess the service line value for appendectomy using scorecards for quality domains and total charges, and prospectively evaluate the management of perforated acute appendicitis in adults.
METHODS: Clinical variables (v=81) from patients (>18yo) who underwent appendectomies were retrieved from a Health System warehouse retrospectively (Jan-2010 to July-2016), and prospectively (Aug-2016 to Sept-2021) including a RCT (Aug-2020 to present), under IRB-approved protocols. Adults with perforated appendicitis were treated with percutaneous drainage and antibiotics and randomized after 12 weeks into interval appendectomy or observation. Patients were followed for 12 months. Value was assessed using two domains: Quality and Charges. Quality (Obs./Exp.) was defined as observed post-operative complications (PC, standardized grading system), LOS, readmission rate (RA), and percentage of textbook cases (TB) compared to expected similar variables determined using ACS NSQIP surgical risk calculator. Charges were assessed as total hospital charges-TC for index admission/re-admission up to 30-days post discharge. Statistical analyses were performed using MatLab r2020b and SPSS.
RESULTS: From patients who underwent appendicectomy (n=1,630), 8% (130) were converted to open from a MI approach (1,418), and 5% (82) underwent an open approach. The mean age and BMI were 37.4±16 and 29.6±7.4 kg/m2, respectively, with an equal gender distribution. Patients with perforated appendicitis (17%) had a significantly higher PC rate (52.8 vs. 16.3%), RA (10.8 vs. 3.6%), LOS (6.5±5.5 vs. 2.1±1.2 days), and TC ($72,574±75,591 vs. $37,034±15,897) when compared to non-perforated cases. Multivariate modeling showed perforated appendicitis status as the only variable that predicts PC (p<0.01). Randomized patients (n=25) to elective surgery vs. observation had a significantly lower complication rate (16.7 %) with no major complications, LOS (3.7±1.4) and no readmission rate. Quality assessment is displayed on Table 1.
CONCLUSION: The service line appendectomy showed a high value in our Health System Network. The service line value for perforated appendicitis increased after medical management and interval appendectomy. Net promoter score (patient satisfaction) and reimbursement index will be added to complement value assessment surrogates.



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