Staplers vs. loop-ligature: a cost analysis from the hospital payer perspective

Area of Science:

• Surgical techniques
• Health economics
• Gastrointestinal surgery

Background:

• Equipoise exists regarding optimal surgical management of the appendiceal stump in laparoscopic appendectomy.
• The cost-effectiveness of routine loop ligature (LLA) versus stapling (LSA) for appendiceal stump closure is debated from a hospital payer perspective.

Purpose of the Study:

• To compare the cost-effectiveness of routine loop ligature (LLA) versus stapler (LSA) for managing the appendiceal stump during emergency laparoscopic appendectomy.

Main Methods:

• A retrospective cohort study of 567 adult patients undergoing emergency laparoscopic appendectomy for acute appendicitis.
• Patients were grouped by surgeon's routine technique: loop ligature (LLA) or stapler (LSA).
• Costs were analyzed using the Ontario Case Costing Initiative and local procurement data; secondary outcomes included OR time, length of stay, and complications.

Main Results:

• Routine loop ligature (LLA) was associated with significantly lower total mean hospital costs ($1988 ± 143) compared to stapler (LSA) ($2253 ± 99; p=0.002).
• Mean disposable costs were substantially reduced with LLA ($310 ± 27) versus LSA ($668 ± 26; p<0.001).
• No significant differences were observed in length of stay (1.5 vs. 1.4 days; p=0.28) or complication rates (8% vs. 10%; p=0.43).

Conclusions:

• Routine use of loop ligature for appendiceal stump closure in laparoscopic appendectomy is more cost-effective than stapler use.
• Adopting loop ligature can lead to significant institutional cost savings without compromising patient outcomes.
• A shift towards routine loop ligature use is recommended for cost-effective surgical care.