Post-appendectomy visits to the emergency department within the global period: A target for cost containment

Francesco A. Aiello, Erica R. Gross, Aleksandra Krajewski, Robert Fuller, Anthony Morgan, Andrew Duffy, Walter Longo, Robert Kozol, Rajiv Chandawarkar

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Postoperative visits to the emergency department (ED) instead of the surgeon's office consume enormous cost. Hypothesis: Postoperative ED visits can be avoided. Setting: Fully accredited, single-institution, 617-bed hospital affiliated with the University of Connecticut School of Medicine. Patients: Retrospective analysis of 597 consecutive patients with appendectomies over a 4-year period. Methods: Demographic and medical data, at initial presentation, surgery, and ED visit were recorded as categorical variables and statistically analyzed (Pearson χ2 test, Fisher exact test, and linear-by-linear). Costs were calculated from the hospital's billing department. Results: Forty-six patients returned to the ED within the global period with pain (n = 22, 48%), wound-related issues (n = 6, 13%), weakness (n = 4, 9%), fever (13%), and nausea and vomiting (n = 3, 6%). Thirteen patients (28%) required readmission. Predictive factors for ED visit postoperatively were perforated appendicitis (2-fold increase over uncomplicated appendicitis) and comorbidities (cardiovascular or diabetes). The cost of investigations during ED visits was $55,000 plus physician services. Conclusions: ED visits during the postoperative global period are avoidable by identifying patients who may need additional care; improving patient education, optimizing pain control, and improving patient office access.

Original languageEnglish
Pages (from-to)357-362
Number of pages6
JournalAmerican Journal of Surgery
Volume200
Issue number3
DOIs
StatePublished - Sep 1 2010
Externally publishedYes

Fingerprint

Appendectomy
Cost Control
Hospital Emergency Service
Appendicitis
Costs and Cost Analysis
Pain
Hospital Departments
Patient Education
Postoperative Period
Nausea
Vomiting
Comorbidity
Fever
Medicine
Demography
Physicians
Wounds and Injuries

Keywords

  • Appendectomy
  • Cost-containment
  • Emergency department visits
  • Global period
  • Postoperative care

ASJC Scopus subject areas

  • Surgery

Cite this

Aiello, F. A., Gross, E. R., Krajewski, A., Fuller, R., Morgan, A., Duffy, A., ... Chandawarkar, R. (2010). Post-appendectomy visits to the emergency department within the global period: A target for cost containment. American Journal of Surgery, 200(3), 357-362. https://doi.org/10.1016/j.amjsurg.2009.10.010

Post-appendectomy visits to the emergency department within the global period : A target for cost containment. / Aiello, Francesco A.; Gross, Erica R.; Krajewski, Aleksandra; Fuller, Robert; Morgan, Anthony; Duffy, Andrew; Longo, Walter; Kozol, Robert; Chandawarkar, Rajiv.

In: American Journal of Surgery, Vol. 200, No. 3, 01.09.2010, p. 357-362.

Research output: Contribution to journalArticle

Aiello, FA, Gross, ER, Krajewski, A, Fuller, R, Morgan, A, Duffy, A, Longo, W, Kozol, R & Chandawarkar, R 2010, 'Post-appendectomy visits to the emergency department within the global period: A target for cost containment', American Journal of Surgery, vol. 200, no. 3, pp. 357-362. https://doi.org/10.1016/j.amjsurg.2009.10.010
Aiello, Francesco A. ; Gross, Erica R. ; Krajewski, Aleksandra ; Fuller, Robert ; Morgan, Anthony ; Duffy, Andrew ; Longo, Walter ; Kozol, Robert ; Chandawarkar, Rajiv. / Post-appendectomy visits to the emergency department within the global period : A target for cost containment. In: American Journal of Surgery. 2010 ; Vol. 200, No. 3. pp. 357-362.
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