A tiered approach to optimize pediatric laparoscopic appendectomy outcomes

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Surgical Cost Analysis

Background:

• Appendicitis surgery represents a significant healthcare cost, with substantial financial variability.
• Current laparoscopic appendectomy practices often involve three incisions (TILS).

Purpose of the Study:

• To evaluate the cost-effectiveness and outcomes of single-incision (SILS) and dual-incision (DILS) laparoscopic appendectomy compared to traditional three-incision laparoscopic appendectomy (TILS).
• To determine if SILS and DILS can reduce healthcare expenditure in pediatric appendicitis management.

Main Methods:

• Retrospective review of 970 pediatric appendectomies performed between January 2015 and December 2017.
• Stratification of appendectomy techniques (SILS, DILS, TILS) against direct variable costs and operative times.
• Analysis of perioperative and 30-day postoperative outcomes.

Main Results:

• SILS and DILS techniques demonstrated significantly lower mean direct variable costs and operating room times compared to TILS.
• These cost and time savings were observed for both acute and complex appendicitis cases.
• Outcomes remained equivalent across all surgical approaches.

Conclusions:

• SILS and DILS appendectomy are viable, cost-effective alternatives to TILS in pediatric surgery.
• Implementing a tiered approach, starting with SILS and adding incisions as needed, can lead to substantial annual cost savings.
• Estimated annual savings of $74,580 for a center performing 314 laparoscopic appendectomies yearly.