Appendicitis Research Today is a free monthly online journal that collates and summarizes the latest research about Appendicitis, including details on symptoms, surgery, causes, treatment. | ||||||||
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Post-appendectomy visits to the emergency department within the global period: a target for cost containment.Aiello FA, Gross ER, Krajewski A, Fuller R, Morgan A, Duffy A, Longo W, Kozol R, Chandawarkar R Department of Surgery, University of Connecticut School of Medicine, Farmington, USA. 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 chi(2) 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. Published 30 August 2010 in Am J Surg, 200(3): 357-62.
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