Cost-effectiveness and superior clinical outcomes of appendectomy are evidenced within 6 months of the index admission for uncomplicated appendicitis compared to nonoperative management

Authors

• Junsik Kwon, Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.
• Bishoy Zakhary, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA.
• Bruno C. Coimbra, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA; George Washington University School of Medicine and Health Sciences, Washington, DC.
• Todd W. Costantini, Division of Critical Care and Acute Care Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN.
• Raul Coimbra, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA; Division of Trauma and Acute Care Surgery, Riverside University Health System Medical Center, Moreno Valley, CA; Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA. Electronic address: [email protected].

Document Type

Journal Article

Publication Date

3-17-2026

Journal

Surgery

Volume

194

DOI

10.1016/j.surg.2026.110150

Abstract

BACKGROUND: Nonoperative management with antibiotics is an alternative to appendectomy for patients with uncomplicated appendicitis. Nonoperative management may reduce initial costs and recovery time, but concerns about recurrence and delayed surgery raise questions about its long-term value. We compared clinical outcomes and determined the cost-effectiveness of appendectomy and nonoperative management using a national data set. METHODS: We selected patients with uncomplicated appendicitis from the Nationwide Readmissions Database (2016-2021). Patients were stratified by appendectomy or nonoperative management at index admission. Outcomes included 6-month readmissions, in-hospital mortality, discharge disposition, and length of stay. Costs included index admission, readmissions, and total expenditures. Cost-effectiveness was assessed as the incremental cost-effectiveness ratio, defined as incremental cost per readmission avoided. Probabilistic sensitivity analysis and cost-effectiveness acceptability curves tested robustness. RESULTS: Among 83,533 patients, 68,908 (82.5%) had appendectomy and 14,625 (17.5%) nonoperative management. Readmissions were higher in nonoperative management (6.3% vs 0.1%). Nonoperative management patients had longer index stays (median 4 vs 2 days), less routine discharge (85.2% vs 95.0%), and greater need for postdischarge care. In-hospital mortality was rare but higher with nonoperative management (0.2% vs 0.1%). Total 6-month costs were modestly lower with nonoperative management ($11,558 vs $12,648), but appendectomy nearly eliminated readmissions. The incremental cost-effectiveness ratio was $17,615 per readmission avoided, with robust sensitivity analyses. CONCLUSIONS: Appendectomy provided definitive cure with near-zero readmissions and an acceptable incremental cost. Nonoperative management offered initial savings, but higher recurrence limited its value. Appendectomy was clinically superior and cost-effective within 6 months, whereas nonoperative management may be reasonable only in select patients or settings.

APA Citation

Kwon, Junsik; Zakhary, Bishoy; Coimbra, Bruno C.; Costantini, Todd W.; and Coimbra, Raul, "Cost-effectiveness and superior clinical outcomes of appendectomy are evidenced within 6 months of the index admission for uncomplicated appendicitis compared to nonoperative management" (2026). GW Authored Works. Paper 8870.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8870

Department

School of Medicine and Health Sciences Student Works