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

doi:10.1016/j.amjsurg.2009.10.010

« Previous Next »The American Journal of Surgery
Volume 200, Issue 3 , Pages 357-362, September 2010

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

Francesco A. Aiello, M.D.
- Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA
Erica R. Gross, M.D.
- Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA
Aleksandra Krajewski, B.S.N.
- Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA
Robert Fuller, M.D.
- Department of Emergency Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
Anthony Morgan, M.D.
- Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA
Andrew Duffy, M.D.
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
Walter Longo, M.D.
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
Robert Kozol, M.D.
- Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA
Rajiv Chandawarkar, M.D.
- Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA
- Corresponding author. Tel.: +1 860 679 4444; fax: +1 860 679 7905

Received 12 April 2009; received in revised form 21 August 2009

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.

Keywords: Appendectomy, Cost-containment, Postoperative care, Emergency department visits, Global period