National Trends in Hospitalizations for Appendectomy in Children, 2001-2017.

Objective: Appendectomy for acute appendicitis is the most common acute surgical procedure in children. Recent changes in appendicitis management have likely modified the nature and cost of hospitalizations for this condition.

Methods: Using data from the National Inpatient Sample from 2001 to 2017, we performed a cross-sectional study and identified the temporal changes in hospitalization for appendectomy. Changes in relative hospitalization cost and length-of-stay were also studied to assess their associations with the changes in procedure incidence. Patient and hospital characteristics were considered to understand outcome disparities between groups. Geographic variation in the outcomes was also identified at the United States region and division levels.

Results: The incidence of appendectomy hospitalization decreased from 11.2 to 6.4 per 10,000 person-years between 2001 and 2017. Conversely, the median procedure cost increased 61% during this same period. The temporal changes in appendectomy hospitalization varied according to patient and hospital characteristics, as well as geographic locations.

Conclusion: The overall incidence of appendectomies in children decreased substantially from 2001 to 2017, yet the trend for costs was in the opposite direction. The data on the clinical factors driving these trends can be useful in guiding policies with evidence-based guidelines that help optimize clinical decisions and the effective use of resources in the management of appendicitis.