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Appendicitis-pediatric surgeons versus general surgeons.

To the Editor —

In the present era of concern about children’s access to pediatric subspecialists, 1 empirical research such as that presented by Kokoska et al, 2 comparing the efficiency of pediatric surgeons with general surgeons in the care of children with acute appendicitis, is commendable. Its application on a statewide basis goes beyond previous evidence in support of surgical specialists limited to a single institution, 3 enhancing this study’s generalizability as well as its statistical power.

The main finding of the study was that hospital length of stay was shorter, leading to lower total costs, for young children cared for by pediatric surgeons compared with general surgeons. The authors subsequently conclude that care delivered by pediatric surgeons was more “cost-effective.” This is a misuse of the term. Cost-effectiveness analysis requires examination of both costs and outcomes, which were not jointly analyzed by Kokoska and colleagues. In fact, it could be argued …