Economics and clinical implications of delayed presentation of children with intussusceptions: minimizing healthcare cost in the context of limited resources.

Abstract

Background A basic strategy in today’s resource-limited healthcare environment is limiting cost while maintaining quality. Objective To estimate the impact and healthcare cost of treatment of intussusceptions (ISs) presenting late. Patients and methods We performed a chart review of children managed for ISs over 44 months. Our care pathway included resuscitation, ultrasound-guided hydrostatic reduction of children presenting early (≤24 h) with no peritonitis. Results There were 46 children seen at a median age of 8.5 months. Thirty-two (69.6%) presented late (>24 h). The total charge was higher for patients who presented late ($259.6 vs. $168.9, P=0.012). There was an average of 21% ($50.0) additional charges incurred for each day’s delay. There was significantly higher cost of drugs ($45.1 vs. $23.7, P=0.008) and procedures ($154.4 vs. $99.5, P=0.025). Those who presented late had increased risk of bowel resection (40 vs. 0%, odds ratio=1.74, P=0.005), and higher complication rates (56 vs. 21%, odds ratio=0.21, P=0.018). The length of stay was doubled for those who presented late (10.6 vs. 4.6 days, P=0.001). Conclusion Delayed presentation of ISs translates to increased hospital cost and an extra week in hospital with increased morbidity.