Non-Operative Management is More Cost-Effective than Immediate Operation in Perforated Appendicitis Patients with Seven or More Days of Symptoms

2019 ◽  
Vol 240 ◽  
pp. 70-79
Author(s):  
Mubina A. Isani ◽  
Jeremy Jackson ◽  
Wesley E. Barry ◽  
Michael U. Mallicote ◽  
David Rosenberg ◽  
...  
Keyword(s):  
Perforated Appendicitis ◽  
Cost Effective ◽  
Operative Management ◽  
Non Operative Management

scholarly journals Selective non-operative management of abdominal stab wounds is a safe and cost effective strategy: A South African experience

2017 ◽  
Vol 99 (6) ◽  
pp. 490-496 ◽  
Author(s):  
KSS Dayananda ◽  
VY Kong ◽  
JL Bruce ◽  
GV Oosthuizen ◽  
GL Laing ◽  
...  
Keyword(s):  
Point Of Care ◽  
Cost Effective ◽  
Operative Management ◽  
Surgical Interventions ◽  
Stab Wounds ◽  
African Experience ◽  
Negative Laparotomy ◽  
Trauma Service ◽  
Abdominal Stab Wounds ◽  
Non Operative Management

INTRODUCTION Selective non-operative management (SNOM) of abdominal stab wounds is well established in South Africa. SNOM reduces the morbidity associated with negative laparotomies while being safe. Despite steady advances in technology (including laparoscopy, computed tomography [CT] and point-of-care sonography), our approach has remained clinically driven. Assessments of financial implications are limited in the literature. The aim of this study was to review isolated penetrating abdominal trauma and analyse associated incurred expenses. METHODS Patients data across the Pietermaritzburg Metropolitan Trauma Service (PMTS) are captured prospectively into the regional electronic trauma registry. A bottom-up microcosting technique produced estimated average costs for our defined clinical protocols. RESULTS Between January 2012 and April 2015, 501 patients were treated for an isolated abdominal stab wound. Over one third (38%) were managed successfully with SNOM, 5% underwent a negative laparotomy and over half (57%) required a therapeutic laparotomy. Over five years, the PMTS can expect to spend a minimum of ZAR 20,479,800 (GBP 1,246,840) for isolated penetrating abdominal stab wounds alone. CONCLUSIONS Provided a stringent policy is followed, in carefully selected patients, SNOM is effective in detecting those who require further intervention. It minimises the risks associated with unnecessary surgical interventions. SNOM will continue to be clinically driven and promulgated in our environment.

Predictors of Outcome for Children with Perforated Appendicitis Initially Treated with Non-Operative Management

2004 ◽  
Vol 5 (4) ◽  
pp. 349-356 ◽  
Author(s):  
Evan P. Nadler ◽  
Kimberly K. Reblock ◽  
Kevin G. Vaughan ◽  
Manuel P. Meza ◽  
Henri R. Ford ◽  
...  
Keyword(s):  
Perforated Appendicitis ◽  
Operative Management ◽  
Predictors Of Outcome ◽  
Non Operative Management

Plate fixation of midshaft clavicle fractures for delayed union and non-union is a cost-effective intervention but functional deficits persist at long-term follow-up

2021 ◽  
pp. 175857322199036
Author(s):  
Ben Fox ◽  
Nicholas David Clement ◽  
Deborah J MacDonald ◽  
Michael Robinson ◽  
Jamie A Nicholson
Keyword(s):  
Functional Outcome ◽  
Cost Effective ◽  
Operative Management ◽  
Matched Cohort ◽  
Non Union ◽  
Oxford Shoulder Score ◽  
Non Operative Management ◽  
Shoulder Score

Background The primary aim of this study was to compare the long-term functional outcome of midshaft clavicle fracture fixation for delayed (≥3 month) and non-union (≥6 month) compared to a matched cohort of patients that achieved union with non-operative management. The secondary aim was to assess cost-effectiveness of fixation. Methods A consecutive series of patients over 10-years were retrospectively reviewed using the QuickDASH, Oxford Shoulder Score and EuroQol five-dimension summary index (EQ-5D). These patients were compared to a matched cohort that achieved union after non-operative management using propensity score matching. Results Sixty patients (follow-up 79%, n = 60/76) at 4.1 years post-operative (1.1–10.0 years) had a QuickDASH of 16.5 (95% CI 11.6–21.5), Oxford Shoulder Score 41.5 (39.0–44.1) and EQ-5D 0.7621 (0.6822–0.8421). One in five patients were dissatisfied with their final outcome ( n = 13/60). Functional outcome was inferior following fixation when compared to patients that united with non-operative management (QuickDASH 16.5 vs. 5.5, p < 0.001 and EQ-5D 0.7621 vs. 0.9073, p = 0.001). However, significant improvements were found when compared to pre-operative scores (QuickDASH p < 0.001 and EQ-5D p < 0.001). The cost per QALY for fixation was £5624.62 for the study cohort. Conclusions Clavicle fixation for delayed and non-union is a cost-effective intervention but outcomes are worse compared to patients that unite with non-operative management.

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