Povidone-iodine intra-abdominal irrigation versus no irrigation in pediatric perforated appendicitis: A secondary economic analysis of a Bayesian randomized controlled trial.

Dalya M Ferguson, K Tinsley Anderson, Elenir B C Avritscher, Seyed A Arshad, Marisa A Bartz-Kurycki, Kevin P Lally, KuoJen Tsao

Journal: American journal of surgery 2024;227():157-160

PMID: 37863798

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

A pilot randomized controlled trial (RCT) conducted in children (2-17 y) with perforated appendicitis demonstrated an 89% probability of reduced intra-abdominal abscess (IAA) rate with povidone-iodine (PVI) irrigation, compared with no irrigation (NI). We hypothesized that PVI also reduced 30-day hospital costs.

METHODS

We conducted a retrospective economic analysis of a pilot RCT. Hospital costs, inflated to 2019 U.S. dollars, were obtained for index admissions and 30-day emergency visits and readmissions. Cost differences between groups were assessed using frequentist and Bayesian generalized linear models.

RESULTS

We observed a 95% Bayesian probability that PVI reduced 30-day mean total hospital costs ($16,555 [PVI] versus $18,509 [NI]; Bayesian cost ratio: 0.90, 95% CrI, 0.78-1.03). The mean absolute difference per patient was $1,954 less with PVI (95% CI, -$4,288 to $379).

CONCLUSIONS

PVI likely reduced the IAA rate and 30-day hospital costs, suggesting the intervention is both clinically superior and cost saving.

Address: Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Sciences Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX, 77030, USA; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School, University of Texas Health Sciences Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX, 77030, USA; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX, 77030, USA. Electronic address: [email protected].; Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Sciences Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX, 77030, USA; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School, University of Texas Health Sciences Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX, 77030, USA; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX, 77030, USA.; Department of Pediatrics, McGovern Medical School, University of Texas Health Sciences Center at Houston, 6431 Fannin Street, MSB 3.020, Houston, TX, 77030, USA.

DOI: 10.1016/j.amjsurg.2023.10.013

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MeSH Terms: Child, Humans, Abdominal Abscess, Appendectomy, Appendicitis, Postoperative Complications, Povidone-Iodine, Child, Preschool, Adolescent