Variability, Outcomes and Cost Associated with the Use of Parenteral Nutrition in Children with Complicated Appendicitis: A Hospital-Level Propensity Matched Analysis
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In brief
In brief
This multi-center retrospective study of 1,073 pediatric patients found that higher parenteral nutrition utilization in complicated appendicitis cases increased 30-day hospital costs by 23% without improving complication rates, surgical site infections, or revisit rates. The findings suggest significant practice variation across hospitals with no measurable clinical benefit from increased PN use.
Written by the GCMD Library team from the article.
Abstract
Background/Purpose
To examine the influence of parenteral nutrition (PN) on clinical outcomes and cost in children with complicated appendicitis.
Methods
Retrospective study of 1,073 children with complicated appendicitis from 29 hospitals participating in the NSQIP-Pediatric Appendectomy Pilot Collaborative (1/2013–6/2015). Mixed-effects regression was used to compare 30-day postoperative outcomes between high and low PN-utilizing hospitals after propensity matching on demographic characteristics, BMI and postoperative LOS as a surrogate for disease severity.
Results
Overall PN utilization was 13.6%, ranging from 0–10.3% at low utilization hospitals (n = 452) and 10.3–32.4% at high utilization hospitals (n = 621). Outcomes were similar between low and high utilization hospitals for rates of overall complications (12.3% vs. 10.5%, OR: 0.80 [0.46,1.37], p = 0.41), SSIs (11.3% vs. 8.8%, OR: 0.72 [0.40,1.32], p = 0.29) and revisits (14.7% vs. 15.9%, OR: 1.10 [0.75,1.61], p = 0.63). Adjusted mean 30-day cumulative hospital cost was 22.9% higher for patients receiving PN ($25,164 vs. $20,478, p < 0.01) after controlling for postoperative LOS.
Conclusion
Following adjustment for patient characteristics and postoperative length of stay, higher rates of PN utilization in children with complicated appendicitis were associated with higher cost but not with lower rates of overall complications, surgical site infections or revisits.
Level of Evidence Level III: Treatment study - Retrospective comparative study