Economics and clinical implications of delayed presentation of children with intussusceptions: minimizing healthcare cost in the context of limited resources.
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
The Egyptian Journal of Surgery, Published by Laredo College
Abstract
Background
A basic strategy in today’s resource-limited healthcare environment is limiting cost
while maintaining quality.
Objective
To estimate the impact and healthcare cost of treatment of intussusceptions (ISs)
presenting late.
Patients and methods
We performed a chart review of children managed for ISs over 44 months. Our care
pathway included resuscitation, ultrasound-guided hydrostatic reduction of children
presenting early (≤24 h) with no peritonitis.
Results
There were 46 children seen at a median age of 8.5 months. Thirty-two (69.6%)
presented late (>24 h). The total charge was higher for patients who presented late
($259.6 vs. $168.9, P=0.012). There was an average of 21% ($50.0) additional
charges incurred for each day’s delay. There was significantly higher cost of drugs
($45.1 vs. $23.7, P=0.008) and procedures ($154.4 vs. $99.5, P=0.025). Those
who presented late had increased risk of bowel resection (40 vs. 0%, odds
ratio=1.74, P=0.005), and higher complication rates (56 vs. 21%, odds
ratio=0.21, P=0.018). The length of stay was doubled for those who presented
late (10.6 vs. 4.6 days, P=0.001).
Conclusion
Delayed presentation of ISs translates to increased hospital cost and an extra week
in hospital with increased morbidity.
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Citation
37(4); 600–605.