Treating appendicitis by laparoscopic surgery may not be worth the cost

Feb 03, 2009

New research published in the February issue of the Journal of the American College of Surgeons suggests that a traditional, "open" appendectomy may be preferable to a less-invasive laparoscopic appendectomy for the majority of patients with acute appendicitis, contrary to recent trends.

Approximately 250,000 appendectomies are performed in the United States each year to treat appendicitis, an inflammation of the appendix that is considered a medical emergency. If treatment is delayed, the appendix can rupture, causing infection and even death.

For almost a century, open appendectomy was the standard treatment for appendicitis, until the 1980s when laparoscopic appendectomy first gained popularity. This transition was based on data that suggested the operation, in which an instrument called a laparoscope is inserted through small incisions in the abdomen, was associated with reduced pain, faster recovery and better cosmetic results.

"The results of this study challenge the current trend toward increased use of laparoscopic appendectomy," said Klaus Thaler, MD, FACS, department of surgery, University of Missouri, Kansas City. "Although laparoscopic surgery is associated with shorter hospital stays, it actually increases costs and may raise the risk of complications in the majority of appendectomy patients."

This retrospective study examined 235,473 patients who underwent open or laparoscopic appendectomy between 2000 and 2005. Length-of-stay, costs and complications were assessed by stratified analysis for uncomplicated (n=169,094) and complicated (n=66,379) appendicitis. Regression methods were used to adjust for covariates and to detect trends.

The study demonstrated that the odds of having any kind of complication were significantly higher in the laparoscopic group among patients with uncomplicated appendicitis (p<0.05, odds ratio = 1.07), and that there was no difference among patients with complicated appendicitis (p=0.74). The only complications reduced by using the laparoscopic approach were infections in the uncomplicated group, and infections and pulmonary complications in the complicated group.

The adjusted costs for laparoscopic appendectomy were 22 percent higher in uncomplicated appendicitis and 9 percent higher in patients with complicated appendicitis (p<0.001). The increased expense for laparoscopic appendectomy are likely related to higher operating room costs, including greater expense for operative instruments and longer operative times. According to the study, laparoscopic appendectomy did result in a reduced length of hospital stay for both the uncomplicated and complicated groups (p<0.001 and p<0.0001, respectively).

Source: Weber Shandwick Worldwide

Explore further: Strategies can help docs lower their tax burden

add to favorites email to friend print save as pdf

Related Stories

NASA HS3 instrument views two dimensions of clouds

5 hours ago

NASA's Cloud Physics Lidar (CPL) instrument, flying aboard an unmanned Global Hawk aircraft in this summer's Hurricane and Severe Storm Sentinel, or HS3, mission, is studying the changing profile of the atmosphere ...

Recommended for you

The human race evolved to be fair for selfish reasons

Sep 19, 2014

"Make sure you play fairly," often say parents to their kids. In fact, children do not need encouragement to be fair, it is a unique feature of human social life, which emerges in childhood. When given the o ...

Non-stop PET/CT scan provides accurate images

Sep 18, 2014

Siemens is improving PET/CT imaging and data quality while reducing radiation exposure. The Biograph mCT Flow PET/CT scanner is a new positron emission tomography/computed tomography (PET/CT) system that, ...

Experts: Chopin's heart shows signs of TB

Sep 17, 2014

The preserved heart of composer Frederic Chopin contains signs of tuberculosis and possibly some other lung disease, medical experts said Wednesday.

User comments : 0