406 Abstracts

decreased from 48% to 36%. Adjusted in-hospital mortality de-clined from 37% to 29%, length of stay decreased from 9.9 to9.2 days, and nursing home discharges increased from 29% to35%. Total hospital costs for severe sepsis increased by 57%($15.4 billion to $24.3 billion), though the geometric meancost per case decreased ($20,210 to $19,330). In comparisonto earlier studies, there was a larger-than-anticipated increasein yearly cases of severe sepsis (8.2% vs. 17.8%), patients hadmore organ system(s) involved, yet cost per case and mortalitydecreased. Changes in medical care (early goal-directed ther-apy/sepsis bundle, low-volume ventilation, protein C) and in-creased frequency of early discharge to nursing homes do notfully account for these changes. The authors hypothesized thatthese paradoxical findings are due to alteration in documenta-tion and coding due to revised ICD codes, improved detectionof organ system dysfunction, and the financial incentives thatall result in upgrading patient disease severity.

[Matthew Taecker, MD

Denver Health Medical Center, Denver, CO]

Comments: The number of cases of severe sepsis has in-creased significantly, yet there has been a sharp decline in mor-tality and cost per case over the same time. Because changes inmedical technology and increased patient throughput do notfully account for this, much of this effect is likely due to changesin hospital billing and coding.

, THE HIDDEN COSTS AND CHARACTERISTICS OFCHILDHOOD ROTAVIRUS EMERGENCY VISITS INCANADA. Le Saux N, Bettinger J, Dery P, et al. Pediatr InfectDis J 2012;31:159–63.

Although some preventable childhood diseases do not havea high rate of mortality, there may be a large economic burdenassociated with their treatment. In this multi-center prospectivestudy, researchers in Canada determined the economic impact,both in and out of the hospital, to families with children diag-nosed with rotavirus. Over 3 years, 199 patients aged 1 monthto 3 years, with rotavirus confirmed by electron microscopy,polymerase chain reaction, or enzyme immunoassay, were en-rolled in the study. Questionnaires were administered on intakeand subsequently, 2 weeks later. Questions included data onhealth care utilization (e.g., physician visits, hospitalization)as well as other costs such as missed work days, travel costs,and supplies specifically needed secondary to the infection(e.g., rehydration fluids, extra diapers). The primary outcomeof economic impact demonstrated initial mean health care costsof $218.10 and mean additional costs of $261.40 in Canadiandollars. The mean total health care costs after 2 weeks for studyparticipants was $341.05, and total mean additional costs were$333.75. The mean total economic burden over the 2-week

study period was $678.80. Other data, such as severity of illness,laboratory results, and coinfected household members, was alsocollected.

[John D. Anderson, MD

Denver Health Medical Center, Denver, CO]

Comments: This study, although limited to survey data,shows a significant economic burden of rotavirus in this popula-tion. Vaccination for rotavirus has demonstrated efficacy inpreventing infection and health care utilization. Improving vac-cination rates thus has the potential to decrease substantial costsassociated with rotavirus infection.

, APPENDECTOMY IN PREGNANCY: EVALUATIONOF THE RISKS OF A NEGATIVE APPENDECTOMY.Ito K, Ito H, Whang EE, Tavakkolizadeh A. Am J Surg2012;203:145–50.

In pregnant women, the negative appendectomy (NA) rate is11–50%, higher than for non-pregnant women. This higher rateis accepted due to the danger that appendicitis poses to the un-born fetus, but the adverse outcomes of NA are not well known.This retrospective chart review evaluated 1696 consecutivepatients (728 men and 968 women) who underwent an appen-dectomy from 1996 to 2005, of whom 87 pregnant womenwere identified. Post-operative surgical and obstetric outcomeswere analyzed based on the final pathologic report of the appen-dix (normal appendix, inflamed, or perforated). The NA ratewassignificantly higher in pregnant women compared with non-pregnant women (36% vs. 14%; p < 0.05). The fetal demiserate was similar between the NA group and the inflamed group(3% vs. 2%; p = NS), and highest (14%) in the perforated group,although this difference did not reach statistical significance(p = 0.3).Wound infections were most frequent in the perforatedgroup (p < 0.05). The authors concluded that NA during preg-nancy is not free of risk to the fetus and, counter to the tradi-tional teaching advocating for early surgical exploration ofpregnant women, they recommend careful assessment to avoidunnecessary exploration when appendicitis is suspected in preg-nant women.

[Douglas Melzer, MD

Denver Health Medical Center, Denver, CO]

Comments:Although limited by both its retrospective designand the small number of true and false positives, this study doesserve as an important reminder of the dangers of intra-abdomi-nal infection and NA in pregnancy. The authors advocate fora strategy of increased imaging to attempt to avoid early explo-ration, and in later pregnancy, this is likely a wise course.Clearly, when possible, ultrasound would be a preferred firsttest before computed tomography.