The Clinical and Economic Correlates of Misdiagnosed Appendicitis

Abstract

<h3>Background</h3> Negative appendectomy (NA)—the nonincidental removal of a normal appendix—occurs commonly but the associated clinical- and system-level costs are not well studied. <h3>Hypothesis</h3> The frequency of adverse clinical outcomes and associated financial burden of hospitalizations during which NA is performed is greater than previously recognized and varies widely among demographic groups. <h3>Design</h3> Population-based, retrospective cohort study. <h3>Setting</h3> The 1997 Nationwide Inpatient Sample of the Health Care Utilization Project. <h3>Patients</h3> All surveyed patients assigned<i>International Classification of Diseases, Ninth Revision</i>procedure codes for appendectomy but without an associated diagnosis of acute appendicitis. <h3>Main Outcome Measures</h3> The age- and sex-stratified rates of NA, the incidence of associated infectious complications and case fatality, and the average length of stay and hospitalization charges during those admissions. <h3>Results</h3> Nationwide, an estimated 261 134 patients underwent nonincidental appendectomies in 1997, and 39 901 (15.3%) were negative for appendicitis. Women had a higher rate of NA as did patients younger than 5 years and older than 60 years. When compared with patients with appendicitis, NA was associated with a significantly longer length of stay (5.8 vs 3.6 days,<i>P</i>&lt;.001), total charge-admission ($18 780 vs $10 584,<i>P</i>&lt;.001), case fatality rate (1.5% vs 0.2%,<i>P</i>&lt;.001), and rate of infectious complications (2.6% vs 1.8%,<i>P</i>&lt;.001). An estimated $741.5 million in total hospital charges resulted from admissions in which a NA was performed. <h3>Conclusions</h3> There are significant clinical and financial costs incurred by patients undergoing NA during the treatment of presumed appendicitis. These should be considered when evaluating system-level interventions to improve the management of appendicitis.