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

doi:10.1016/j.amjsurg.2023.10.013

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

Am J Surg. 2024 Jan:227:157-160. doi: 10.1016/j.amjsurg.2023.10.013. Epub 2023 Oct 5.

Authors

Dalya M Ferguson¹, K Tinsley Anderson², Elenir B C Avritscher³, Seyed A Arshad², Marisa A Bartz-Kurycki², Kevin P Lally², KuoJen Tsao²

Affiliations

¹ 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: dalya.m.ferguson@uth.tmc.edu.
² 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.
³ Department of Pediatrics, McGovern Medical School, University of Texas Health Sciences Center at Houston, 6431 Fannin Street, MSB 3.020, Houston, TX, 77030, USA.

PMID: 37863798
DOI: 10.1016/j.amjsurg.2023.10.013

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.

Keywords: Healthcare costs; Intra-abdominal irrigation; Perforated appendicitis; Povidone-iodine.

Publication types

Randomized Controlled Trial

MeSH terms

Abdominal Abscess* / therapy
Adolescent
Appendectomy
Appendicitis* / complications
Appendicitis* / surgery
Child
Child, Preschool
Humans
Postoperative Complications
Povidone-Iodine / therapeutic use

Substances

Povidone-Iodine