One-Year Healthcare Utilization and Costs After Emergency Department Encounters for Uncomplicated Appendicitis: A Statewide Observational Study.

OBJECTIVE

Non-operative management with antibiotics has emerged as an alternative to appendectomy for uncomplicated appendicitis. This study compared one-year healthcare costs and utilization outcomes after operative versus non-operative management of uncomplicated appendicitis using statewide administrative data.

METHODS

We conducted a statewide observational study using linked Healthcare Cost and Utilization Project (HCUP) databases from Maryland (2016-2021) including emergency department, inpatient, and ambulatory surgery encounters. Adults with uncomplicated appendicitis, identified by ICD-10 codes and excluding complicated cases, were analyzed. Operative management was defined as appendectomy during the index hospitalization, non-operative management as initial treatment without appendectomy. The primary outcome was total healthcare cost within one year of the index visit. Secondary outcomes included emergency department revisits, hospital readmissions, and cumulative hospital length of stay. Inverse probability of treatment weighting based on propensity scores was used to balance covariates, and generalized linear models estimated adjusted outcomes.

RESULTS

Among 15 754 patients, 14 056 (89.2%) underwent appendectomy and 1698 (10.8%) received non-operative management. Adjusted mean one-year costs were significantly lower for appendectomy ($6241) than for non-operative management ($8187). Operative management was also associated with fewer emergency department revisits (0.69 vs. 1.00 per patient), fewer readmissions (0.11 vs. 0.34 per patient), and shorter total hospital stays (3.84 vs. 5.87 days) (all p < 0.001).

CONCLUSION

Initial appendectomy for uncomplicated appendicitis was associated with lower one-year healthcare costs, fewer emergency department revisits, and fewer readmissions compared with non-operative management. These findings suggest that early surgery may reduce long-term healthcare utilization.