Health care utilization after operative versus nonoperative appendicitis management using an administrative claims database.

Abstract

Background: Use of nonoperative management for uncomplicated appendicitis is increasing. Recurrent appendicitis is only one measure of successful nonoperative management. We examined health care utilization and exposure to medical imaging between patients postappendectomy and those with an in situ appendix over the year after initial diagnosis. We hypothesized that nonoperative management would result in greater health care utilization than operative management in the year following index diagnosis.

Methods: Using MarketScan, a commercial and fee-for-service Medicare claims database, we extracted patients presenting to the emergency department (ED) with acute appendicitis and without perforation from 2017 to 2021, and either underwent appendectomy during index presentation or nonoperative treatment. We examined differences in abdominal pain related health care utilization within 1-year including ED visits, hospitalizations, and abdominal computed tomography (CT) scans associated with the most common causes of ED presentation for abdominal pain.

Results: Of 26,588 patients presenting with uncomplicated appendicitis (female, 50.4%; mean [SD] age, 37.9 [15.3] years; mean [SD] Elixhauser comorbidity index, 0.8 [1.2]), 24,102 (90.6%) underwent appendectomy. At 1 year, 2,544 (9.6%) represented to the ED with an abdominal pain and/or appendicitis related diagnosis. Of nonoperatively managed patients, 78 (3.1%) underwent appendectomy for recurrent appendicitis at a median of 70 days, and 396 (15.9%) represented to the ED but did not undergo appendectomy. Emergency department visits, subsequent hospitalization, and abdominal CT scans were more common in the nonoperative group. After adjusting for patient sex, age, and Elixhauser comorbidity index, patients managed nonoperatively were approximately twice as likely (relative risk [RR], 2.10 [1.90-2.31]) to represent to the ED, be hospitalized (RR, 2.32 [1.94-2.76]), or undergo a CT scan (RR, 1.87 [1.68-2.08]) within 1 year.

Conclusion: After adjusting for baseline characteristics, nonoperative management of uncomplicated appendicitis was associated with representation to the ED, rehospitalization, and repeat CT imaging.

Level of evidence: Therapeutic/Care Management; Level III.