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Related Concept Videos

Appendicitis-II: Diagnostic Studies and Management01:29

Appendicitis-II: Diagnostic Studies and Management

Diagnosing and managing appendicitis requires a structured and comprehensive approach that spans from initial assessment to postoperative care. Here is an overview of the process:
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
Appendicitis01:19

Appendicitis

Appendicitis is an acute inflammatory condition of the vermiform appendix, most commonly caused by obstruction of its lumen. The appendix is a narrow, blind-ended pouch that extends from the cecum, making it particularly prone to obstruction. Causes include fecaliths, lymphoid hyperplasia (often after viral infections), parasites, tumors, or foreign bodies. This obstruction initiates a cascade of pathological changes.Luminal Obstruction and Early InflammationAfter obstruction, normal mucosal...

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Related Experiment Video

Updated: Jun 17, 2026

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Surgeon practice patterns drive procedural cost variation in appendectomy without improving short-term outcomes.

R M Dallal1,2, A R Bloom3,4, J Zirnheld5

  • 1Department of Surgery, Jefferson Health, Philadelphia, PA, USA. ramsey.dallal@jefferson.edu.

Surgical Endoscopy
|June 16, 2026
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Summary

Surgeon practice patterns significantly drive appendectomy costs, with higher spending not improving outcomes. Focusing on surgeon costs can enhance value in emergency surgery.

Keywords:
AppendectomyClinical outcomesCost effectivenessRobotic surgerySurgeon variation

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Area of Science:

  • General Surgery
  • Health Economics
  • Minimally Invasive Surgery

Background:

  • Appendectomy is a common emergency procedure, increasingly using minimally invasive techniques.
  • Robotic platforms are underutilized in appendectomy despite their use in elective surgery.
  • Significant cost variations exist in emergency general surgery, particularly at the surgeon level.

Purpose of the Study:

  • To analyze cost variations in appendectomy based on operative approach and provider-level effects.
  • To evaluate the association between operative approach, cost, and short-term clinical outcomes.
  • To identify drivers of cost variation and strategies for improving value in emergency general surgery.

Main Methods:

  • Retrospective cohort study of 11,153 adult appendectomies (2017-2025).
  • Operative approaches: open, laparoscopic, and robotic.
  • Hierarchical mixed-effects regression models to assess cost and outcomes, accounting for surgeon and hospital effects.

Main Results:

  • Laparoscopic approach dominated (95.3%).
  • Surgeon-level effects explained 28% of cost variation, exceeding hospital contributions (11%).
  • Robotic appendectomy increased costs without improving outcomes; higher costs correlated with longer OR time and LOS, but not reintervention rates.

Conclusions:

  • Surgeon practice patterns are the primary driver of cost variation in appendectomy.
  • Increased spending does not correlate with improved efficiency or short-term clinical outcomes.
  • Surgeon-focused cost transparency and standardization can improve value in emergency general surgery without compromising safety.