WP4.1 - Costs of acute appendicitis in COVID-19 pandemic period: a cohort study

Abstract

Abstract Aims During COVID 19 pandemic, aerosol generating procedures were deemed high risk for patients & staff. NHS England set guidelines on appendicitis management, thus acute appendictomy rates were reduced. Aim of study is to assess cost implications of appendicitis management at a single centre. Methods Cohort study carried out from Mar'2020 to Jan'2024. Descriptive demography & post-operative outcomes were evaluated in appendicitis in COVID19, post-COVID19 appendicitis were controls. Costing calculated using the standardised NHS cost ledger for resources, procurement and services Results COVID (n = 306) Post COVID (n = 446) Interval (n = 45) Kruskal Wallis (p value) Age(yrs) 35.2 38.0 47.9 < 0.0005 Sex(M : F) 155 : 151 216 : 230 19 : 26 NS BMI(kg/m2) 25.4 25.8 26.5 NS GP 49 162 A & E 257 284 WCC(x109/L) 12.5 13.1 6.5 < 0.0001 CRP(mg/L) 67.2 70.9 3.4 < 0.0001 Conservative(n) 148 87 0 < 0.0001 Surgery(n) 158 359 45 < 0.0001 Open(n) 6 2 0 NS Lap(n) 300 444 45 < 0.0001 ASA(median) 2 1 2 NS Uncomplicated 178 170 42 < 0.0001 Complicated 128 276 3 < 0.0001 Clinical 0 21 USS scan 89 113 CT scan 334 312 Op time(mins) 72.8 75.9 74.4 NS LOS(days)(med) 2 2 0 < 0.0001 IP AB(days) 2 2 0 < 0.0001 Post-op AB(days) 5 3 0 < 0.0001 Appendix HPA(mm) Length 66.8 66.5 55.7 < 0.005 Diameter 11.5 11.1 9.9 NS Cost(£) 2160 4422 1046 < 0.0001 Conclusion Clinically & radiologically grading of appendicitis (uncomplicated or complicated) has allowed safe conservative management (antibiotic therapy). Non surgical management is cheaper for index admission, but there are additional costs & workload.