WP5.14 - Cost of conservative management of acute appendicitis: a cohort study

Abstract Aims Potential benefits of non surgical treatment of appendicitis: low risk treatment, suitable for older patients, avoids negative appendicectomy & lower healthcare costs. It is associated with recurrent appendicitis, prolonged hospitization, antibiotic related complications, prolonged follow up. Aim of study is to assess costs of conservative management. Methods Cohort study was carried out from Mar'2020 to Dec'2023 at single centre. Descriptive demography & outcomes were evaluated for non surgical management. Appendicectomy (acute & interval) were used as controls. Costing was calculated using the standardised NHS cost ledger for resources, procurement and services. Results Conservative (n = 235) Appendicectomy (n = 518) Interval (n = 45) Kruskal Wallis (p value) Age(yrs) 39.0 35.9 47.9 <0.0001 Sex(M : F) 121 : 114 251 : 267 19 : 26 NS BMI(kg/m2) 26.0 25.5 26.5 NS GP(n) 69 143 NS A&E(n) 166 375 NS WCC(x109/L) 12.0 13.2 6.5 <0.0001 CRP(mg/L) 76.3 66.3 3.4 <0.0001 Open(n) 11 0 NS Lap(n) 507 45 NS ASA(med) 1 2 NS Appendgrade(n) Uncomplicated 161 186 42 <0.0001 Complicated 74 332 3 <0.0001 Diagnostic (n) Clinical 9 34 USS scan 65 138 CT scan 161 346 Op time(mins) 74.9 74.4 NS LOS(days)(med) 2 2 0 <0.0001 IP AB(days) 2 2 0 <0.0001 Post-op AB(days) 7 0 0 <0.0001 App HPA(mm) Length 66.6 55.7 <0.001 Diameter 11.2 9.9 NS Normal(HPA)(n) 41 Appendicitis (HPA)(n) 477 Cost(£) 1529 4269 1046 <0.0001 Conclusions Appendicitis grading clinically & radiologically has facilitated safe conservative management. Costs is lower for index admission, but is associated with additional costs & workload.