Cost of open versus laparoscopic appendectomy.

Area of Science:

• Surgical Outcomes
• Health Economics
• Comparative Effectiveness

Background:

• Existing literature compares open appendectomy (OA) and laparoscopic appendectomy (LA) outcomes.
• Few studies adjust for age, hospital function, or region when assessing cost and outcome variations.
• Appendectomy is a common surgical procedure for appendicitis.

Purpose of the Study:

• To examine differences in cost and procedure-related complications between OA and LA.
• To adjust for age and hospital factors in comparing OA and LA outcomes.
• To provide a comprehensive economic analysis of appendectomy procedures.

Main Methods:

• Retrospective analysis of 1703 appendectomy patients from 76 academic and 80 community hospitals.
• Analysis of demographic, clinical variables, length of stay (LOS), total charges (TC), and complication rates for OA and LA.
• Multivariate analysis to identify LA's specific contributions to LOS, TC, and complication rates.

Main Results:

• 1469 patients underwent OA (86.3%) and 234 underwent LA (13.7%).
• Complication rates were 3.4% for OA and 2.6% for LA (p=0.504).
• After risk adjustment, LA was associated with higher total charges ($1458, p<0.001) but showed no significant differences in LOS or complication rates compared to OA.

Conclusions:

• Laparoscopic appendectomy (LA) is associated with increased total charges compared to open appendectomy (OA).
• LA does not significantly impact length of stay or complication rates.
• Further research on quality of life and subgroup analyses (e.g., obese patients) is recommended for a complete economic evaluation.