Appendicitis, a common and potentially serious medical condition, requires prompt diagnosis and treatment to ensure optimal patient outcomes. Timely intervention is critical, as Delayed Diagnosis Inpatient Care for appendicitis can lead to increased complications and greater healthcare resource utilization. However, the specific economic impact of delayed diagnosis on appendicitis hospital care costs has not been fully understood.
This study, published in a peer-reviewed journal, aimed to investigate the association between delayed appendicitis diagnosis and the resultant hospital care expenditures. Researchers conducted a retrospective cohort study utilizing data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient and Emergency Department databases. The analysis included patients aged 18 to 64 who underwent appendectomy across five diverse states – Florida, Maryland, Massachusetts, New York, and Wisconsin – during 2016 and 2017. This large-scale dataset allowed for a robust assessment of the financial implications of delays in diagnosis.
The research team defined “delayed diagnosis” as instances where patients had a prior emergency department (ED) or inpatient encounter with an abdominal diagnosis other than appendicitis within the 7 days preceding their appendectomy. Crucially, these patients received no surgical or interventional treatment during that initial encounter. This definition effectively captured cases where appendicitis might have been initially missed or misdiagnosed, leading to a delay in appropriate surgical intervention and subsequent inpatient care.
The primary outcome measured was appendicitis hospital care costs. This comprehensive cost metric encompassed charges accumulated from encounters within 7 days before the appendectomy, the appendectomy encounter itself, and the 30-day postoperative period. To ensure accurate cost estimation, the researchers applied cost-to-charge ratios to convert hospital charges into actual costs. These costs were further adjusted to account for variations in wage indices, inflation up to 2022 US dollars, and to mitigate the influence of extreme cost outliers through winsorization. A multivariable Poisson regression model was employed to isolate the impact of delayed diagnosis on hospital costs, controlling for a wide range of potentially confounding variables. These included patient demographics (age, sex, race, ethnicity), insurance status, care discontinuity, income quartile, and hospital characteristics (size, teaching status, medical school affiliation, patient demographics, location). This rigorous statistical approach strengthened the study’s ability to attribute cost differences specifically to delayed diagnosis rather than other factors.
The study population comprised 76,183 patients who underwent appendectomy. Of these, a notable 2,045 patients (2.7%) experienced a delayed diagnosis. The unadjusted median hospital care cost for patients with delayed diagnosis was significantly higher at $11,099 (IQR $6,752-$17,740) compared to $9,177 (IQR $5,575-$14,481) for those without delay (p<0.001). This raw cost difference clearly indicates a greater financial burden associated with delayed diagnosis. After adjusting for the aforementioned covariates using multivariable regression, the results remained statistically significant. Delayed diagnosis of appendicitis was associated with a significant 11.4% increase in appendicitis hospital care costs (95% CI, 8.3%-14.6%, p<0.001). This adjusted figure provides a more precise estimate of the incremental cost attributable to delays in diagnosis, independent of other patient and hospital factors.
In conclusion, this large cohort study provides compelling evidence that delayed diagnosis inpatient care for appendicitis is associated with substantially increased hospital care costs. These findings underscore the critical importance of timely and accurate diagnosis of appendicitis to not only improve patient outcomes but also to mitigate the economic burden on healthcare systems. Reducing delays in appendicitis diagnosis represents a significant opportunity to enhance the value of inpatient care by improving both clinical and financial outcomes. Healthcare providers and systems should prioritize strategies aimed at improving diagnostic accuracy and reducing delays in care for patients presenting with suspected appendicitis.
