Variability in Hospital Costs for Short Stay Emergent Laparoscopic Appendectomy

Background: Acute care surgery (ACS) diagnoses including appendicitis comprise 20% of inpatient admissions in the U.S. and 25% of hospital costs. To inform cost reduction efforts, we sought to measure variability in hospital costs for short stay emergent laparoscopic appendectomy.

Methods: VIZIENT Clinical Data Base was queried for adult and pediatric patients who underwent emergent laparoscopic appendectomy for appendicitis with length of stay ≤3 days. We extracted calendar FY 2019 direct costs (DC) by age group and diagnosis code for sites reporting at least 5 cases. Costs in the database are derived from actual charges multiplied by a site- and cost center-specific cost-to-charge ratio. Labor portions are scaled by the area wage index. Sites were ranked by vigintile of DC per case to provide confidentiality and blinding.

Results: In a total of 128 hospitals, median number of cases per site was 35.5 (Interquartile range (IQR) 20-65) with a total of 6585 cases analyzed. Highest cost centers by descending order were OR, Medical/Surgical Supplies, Routine Floor Care, Pharmacy, Emergency Room, Anesthesia, Laboratory, and CT scans, with all others each less than 2% of total costs. The relation between OR costs and total costs was strong but not complete. Mean DC per case was $4609. DC did not correlate with age, diagnosis code, or case volume per site.

Conclusions: Wide variation in cost of laparoscopic appendectomy among medical centers suggests potential for significant cost reduction. Strategic opportunities in cost reduction appear to lie inside and outside the OR.

Key Message: Wide variation in cost of laparoscopic appendectomy and individual cost centers suggest a multi-pronged cost-reduction strategy should be used.