Laparoscopic Appendectomy-Is it Worth the Cost? Trend Analysis in the US from 2000 to 2005

Emanuel Sporn, Gregory F. Petroski, Gregory Mancini, J. Andres Astudillo, Brent W. Miedema, Klaus Thaler

Research output: Contribution to journalArticle

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Abstract

Background: Although laparoscopic appendectomy is widely used for treatment of appendicitis, it is still unclear if it is superior to the open approach. Study Design: From the Nationwide Inpatient Sample 2000 to 2005, hospitalizations with the primary ICD-9 procedure code of laparoscopic (LA) and open appendectomy (OA) were included in this study. Outcomes of length of stay, costs, and complications were assessed by stratified analysis for uncomplicated and complicated appendicitis (perforation or abscess). Regression methods were used to adjust for covariates and to detect trends. Costs were rescaled using the hospital and related services portion of the Medical Consumer Price Index. Results: Between 2000 and 2005, 132,663 (56.3%) patients underwent OA and 102,810 (43.7%) had LA. Frequency of LA increased from 32.2% to 58.0% (p < 0.001); conversion rates decreased from 9.9% to 6.9% (p < 0.001). Covariate adjusted length of stay for LA was approximately 15% shorter than for OA in both uncomplicated and complicated cases (p < 0.001). Adjusted costs for LA were 22% higher in uncomplicated appendicitis and 9% higher in patients with complicated appendicitis (p < 0.001). Costs and length of stay decreased over time in OA and LA. The risk for a complication was higher in the LA group (p < 0.05, odds ratio = 1.07, 95% CI 1.00 to 1.14) with uncomplicated appendicitis. Conclusions: LA results in higher costs and increased morbidity for patients with uncomplicated appendicitis. Nevertheless, LA is increasingly used. Patients undergoing LA benefit from a slightly shorter hospital stay. In general, open appendectomy may be the preferred approach for patients with acute appendicitis, with indication for LA in selected subgroups of patients.

Original languageEnglish (US)
JournalJournal of the American College of Surgeons
Volume208
Issue number2
DOIs
StatePublished - Jan 1 2009

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Appendectomy
Appendicitis
Costs and Cost Analysis
Length of Stay
International Classification of Diseases
Abscess
Inpatients
Hospitalization
Odds Ratio
Economics
Morbidity

All Science Journal Classification (ASJC) codes

  • Surgery

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Laparoscopic Appendectomy-Is it Worth the Cost? Trend Analysis in the US from 2000 to 2005. / Sporn, Emanuel; Petroski, Gregory F.; Mancini, Gregory; Astudillo, J. Andres; Miedema, Brent W.; Thaler, Klaus.

In: Journal of the American College of Surgeons, Vol. 208, No. 2, 01.01.2009.

Research output: Contribution to journalArticle

Sporn, Emanuel ; Petroski, Gregory F. ; Mancini, Gregory ; Astudillo, J. Andres ; Miedema, Brent W. ; Thaler, Klaus. / Laparoscopic Appendectomy-Is it Worth the Cost? Trend Analysis in the US from 2000 to 2005. In: Journal of the American College of Surgeons. 2009 ; Vol. 208, No. 2.
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abstract = "Background: Although laparoscopic appendectomy is widely used for treatment of appendicitis, it is still unclear if it is superior to the open approach. Study Design: From the Nationwide Inpatient Sample 2000 to 2005, hospitalizations with the primary ICD-9 procedure code of laparoscopic (LA) and open appendectomy (OA) were included in this study. Outcomes of length of stay, costs, and complications were assessed by stratified analysis for uncomplicated and complicated appendicitis (perforation or abscess). Regression methods were used to adjust for covariates and to detect trends. Costs were rescaled using the hospital and related services portion of the Medical Consumer Price Index. Results: Between 2000 and 2005, 132,663 (56.3{\%}) patients underwent OA and 102,810 (43.7{\%}) had LA. Frequency of LA increased from 32.2{\%} to 58.0{\%} (p < 0.001); conversion rates decreased from 9.9{\%} to 6.9{\%} (p < 0.001). Covariate adjusted length of stay for LA was approximately 15{\%} shorter than for OA in both uncomplicated and complicated cases (p < 0.001). Adjusted costs for LA were 22{\%} higher in uncomplicated appendicitis and 9{\%} higher in patients with complicated appendicitis (p < 0.001). Costs and length of stay decreased over time in OA and LA. The risk for a complication was higher in the LA group (p < 0.05, odds ratio = 1.07, 95{\%} CI 1.00 to 1.14) with uncomplicated appendicitis. Conclusions: LA results in higher costs and increased morbidity for patients with uncomplicated appendicitis. Nevertheless, LA is increasingly used. Patients undergoing LA benefit from a slightly shorter hospital stay. In general, open appendectomy may be the preferred approach for patients with acute appendicitis, with indication for LA in selected subgroups of patients.",
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AB - Background: Although laparoscopic appendectomy is widely used for treatment of appendicitis, it is still unclear if it is superior to the open approach. Study Design: From the Nationwide Inpatient Sample 2000 to 2005, hospitalizations with the primary ICD-9 procedure code of laparoscopic (LA) and open appendectomy (OA) were included in this study. Outcomes of length of stay, costs, and complications were assessed by stratified analysis for uncomplicated and complicated appendicitis (perforation or abscess). Regression methods were used to adjust for covariates and to detect trends. Costs were rescaled using the hospital and related services portion of the Medical Consumer Price Index. Results: Between 2000 and 2005, 132,663 (56.3%) patients underwent OA and 102,810 (43.7%) had LA. Frequency of LA increased from 32.2% to 58.0% (p < 0.001); conversion rates decreased from 9.9% to 6.9% (p < 0.001). Covariate adjusted length of stay for LA was approximately 15% shorter than for OA in both uncomplicated and complicated cases (p < 0.001). Adjusted costs for LA were 22% higher in uncomplicated appendicitis and 9% higher in patients with complicated appendicitis (p < 0.001). Costs and length of stay decreased over time in OA and LA. The risk for a complication was higher in the LA group (p < 0.05, odds ratio = 1.07, 95% CI 1.00 to 1.14) with uncomplicated appendicitis. Conclusions: LA results in higher costs and increased morbidity for patients with uncomplicated appendicitis. Nevertheless, LA is increasingly used. Patients undergoing LA benefit from a slightly shorter hospital stay. In general, open appendectomy may be the preferred approach for patients with acute appendicitis, with indication for LA in selected subgroups of patients.

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