Appendicitis hospitalization care costs higher among patients with delayed diagnosis of appendicitis

1. In a cohort of individuals who underwent an appendectomy, those with a delayed diagnosis had higher hospital costs than those diagnosed at a normal time. 

2. Hospital care costs for appendicitis were higher among non-Hispanic Black individuals than non-Hispanic White individuals. 

Evidence Rating Level: 1 (Excellent)

Delayed appendicitis has been associated with worse outcomes along with a longer hospital stay and increased appendectomy time. It is unknown if delayed diagnosis is associated with higher hospital costs related to appendicitis. To address this gap in the literature, researchers sought to further characterize hospital care for appendicitis and the differences relating to delayed diagnosis. Thus, the study enrolled participants between the ages of 18 to 64 years who had previously undergone a laparoscopic appendectomy for appendicitis. Hospital care costs for aggregated appendicitis were the primary outcome with the hospital perspective being used. The cohort included 76 183 participants (2192 Asian or Pacific Islander [2.9%], 14 132 Hispanic [18.5%], 8195 non-Hispanic Black [10.8%], 46 949 non-Hispanic White [61.6%]) who had previously received an appendectomy, with only 2045 (2.7%) having a delayed diagnosis. Patients who had a delayed diagnosis had a median (IQR) unadjusted cost of $11 099 ($6752- $17 740) compared to a cost of $9177 ($5575-$14 481) for the nondelayed group (P<.001). Specifically, the median (IQR) cost was higher in the non-Hispanic Black individuals with a nondelayed diagnosis ($13 027 [$8004-$19 947]) compared to non-Hispanic Black individuals with a delayed diagnosis ($10 650 [$6471-$17 074]). Appendicitis hospital cost was 1.23 times (95% CI, 1.16-1.28 times) higher in the delayed diagnosis group after controlling for confounding factors such as sex, ethnicity, and income quartile. Non-Hispanic Black individuals made up a greater proportion of the delayed diagnosis cohort and had 1.22 times (95% CI, 1.17-1.28) higher appendicitis cost than non-White Hispanic individuals. Delayed appendicitis diagnosis and as a result, worse quality health care is more prevalent in racial and ethnic minority groups. Finding ways to reduce delayed diagnosis could help hospitals reduce their overall costs of care. Overall, higher hospital costs were associated with a delayed diagnosis of appendicitis, with the highest costs being unequally distributed to minority groups. 

Click to read the study in JAMA Network Open

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