Hem-O-Lock Clip to Replace Stapler for Laparoscopic Appendectomy Provides Value-Based Care

Area of Science:

• Surgical Innovation
• Cost-Effectiveness in Healthcare

Background:

• Laparoscopic appendectomy (LA) is the standard treatment for acute appendicitis.
• Stump closure methods, such as Hem-O-Lok clips (HOL) and endoscopic staplers (ES), vary in cost.
• Evaluating cost-saving strategies without compromising patient outcomes is crucial in healthcare.

Purpose of the Study:

• To compare the cost-effectiveness of Hem-O-Lok clips (HOL) versus endoscopic staplers (ES) for stump closure during laparoscopic appendectomy (LA).
• To evaluate if HOL clips can provide cost savings without negatively impacting patient outcomes.

Main Methods:

• Retrospective case-control study of 571 patients undergoing LA from 2016-2022.
• Patients were divided into groups based on stump closure: HOL clips (n=341) or ES (n=230).
• Propensity score matching (1:1) created 177 pairs, controlling for age, sex, BMI, and ASA classification.
• Outcomes assessed included 30-day complications, length of stay, estimated blood loss (EBL), and readmission rates.

Main Results:

• The HOL group had patients who were older, had more comorbidities, higher BMI, and higher ASA classifications.
• Despite demographic and comorbidity differences, no increased post-operative complication rates were observed between HOL and ES groups.
• Return to hospital rates were similar: 5.3% for HOL vs. 7.9% for ES.
• Cost analysis revealed HOL clips ($32 for a six-pack) are significantly cheaper than ES ($273 per load).

Conclusions:

• Hem-O-Lok clips are a safe and effective alternative for stump closure in laparoscopic appendectomy.
• Utilizing HOL clips demonstrates no increase in patient morbidity compared to endoscopic staplers.
• HOL clips represent a substantial cost-saving opportunity for healthcare systems performing LA.