Outcomes and cost analysis of laparoscopic versus open appendectomy for treatment of acute appendicitis: 4-years experience in a district hospital

Vincenzo Minutolo, Alessio Licciardello, Biagio Di Stefano, Manuel Arena, Goffredo Arena, Vincenzo Antonacci, Vincenzo Minutolo, Alessio Licciardello, Biagio Di Stefano, Manuel Arena, Goffredo Arena, Vincenzo Antonacci

Abstract

Background: Laparoscopic appendectomy is not yet unanimously considered the "gold standard" in the treatment of acute appendicitis because of its higher operative time, intra-abdominal abscess risk, and costs compared to open appendectomy. This study aimed to compare outcomes and cost of laparoscopic and open appendectomy in a district hospital.

Methods: A retrospective analysis of 230 patients who underwent appendectomy at the Division of General Surgery of the Civil Hospital of Ragusa, Italy, from May 2008 to May 2012 was performed. The variables analyzed included patients data (age, gender, previous abdominal surgery, preoperative WBC count, duration of symptoms, ASA risk score), rate of uncomplicated or complicated appendicitis, operative time, postoperative complications, length of hospital stay, and total costs. The patients were divided in two groups according to the surgical approach and compared for each variable. The results were analyzed using the t Student test for quantitative variables, and the Chi-square test with Yates correction and Fisher exact test for categorical.

Results: Laparoscopic appendectomy was performed in 139 patients, open appendectomy in 91. Two cases (1.4%) were converted to open procedure and included in the laparoscopic group data. Patient data and rate of complicated appendicitis were similar in the two study groups. There was no statistical difference (p = 0.476) in the mean operative time between the laparoscopic (52.2 min; range, 20-155) and open appendectomy (49.3 min; range, 20-110) groups. The overall incidence of minor and major complications was significantly lower (p = 0.006) after laparoscopic appendectomy (2.9%, 4 cases) than after open appendectomy (13.2%, 12 cases); rate of intra-abdominal abscess were similar. The length of hospital stay was significantly shorter (p = 0.001) in laparoscopic group (2.75 days; range, 1-8) than in open group (3.87 days; range, 1-19). The mean total cost was 2282 Euro in laparoscopic group and 2337 Euro in open group, with a no significant difference of 55 Euro (p = 0.812).

Conclusion: Laparoscopic appendectomy is associated with fewer complications, shorter hospital stay, and similar operative time, intra-abdominal abscess rate, and total costs, compared with open appendectomy. Therefore, laparoscopic appendectomy can be recommended as preferred approach in acute appendicitis.

References

    1. Semm K. Endoscopic appendectomy. Endoscopy. 1983;15:59–64. doi: 10.1055/s-2007-1021466.
    1. McGrath B, Buckius MT, Grim R, Bell T, Ahuja V. Economics of appendicitis: cost trend analysis of laparoscopic versus open appendectomy from 1998 to 2008. J Surg Res. 2011;171:e161–e168. doi: 10.1016/j.jss.2011.06.067.
    1. Ortega AE, Hunter JG, Peters JH, Swanstrom LL, Schirmer B. A prospective, randomized comparison of laparoscopic appendectomy with open appendectomy. Laparoscopic Appendectomy Study Group. Am J Surg. 1995;169:208–212. doi: 10.1016/S0002-9610(99)80138-X.
    1. Fingerhut A, Millat B, Borrie F. Laparoscopic versus open appendectomy: time to decide. World J Surg. 1999;1999(23):835–845.
    1. Minutolo V, Gagliano G, Minutolo O, Carnazza M, La Terra S, Buttafuoco A, Dipietro S, Lanteri R. Laparoscopic appendectomy for acute appendicitis. Chir Ital. 2009;61:591–596.
    1. Milewczyk M, Michalik M, Ciesielski M. A prospective, randomized, unicenter study comparing laparoscopic and open treatments of acute appendicitis. Surg Endosc. 2003;17:1023–1028. doi: 10.1007/s00464-002-9112-3.
    1. Pedersen AG, Petersen OB, Wara P, Rønning H, Qvist N, Laurberg S. Randomized clinical trial of laparoscopic versus open appendicectomy. Br J Surg. 2001;88:200–205. doi: 10.1046/j.1365-2168.2001.01652.x.
    1. Sauerland S, Lefering R, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2010;10:CD001546.
    1. Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG, Wei HB. Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis. Surg Endosc. 2011;25:1199–1208. doi: 10.1007/s00464-010-1344-z.
    1. Krisher SL, Browne A, Dibbins A, Tkacz N, Curci M. Intraabdominal abscess after laparoscopic appendectomy for perforated appendicitis. Arch Surg. 2001;136:438–441. doi: 10.1001/archsurg.136.4.438.
    1. Loh A, Taylor RS. Laparoscopic appendectomy. Br J Surg. 1992;27:289–290.
    1. Schreiber JH. Early experience with laparoscopic appendectomy in women. Surg Endosc. 1987;1:211–216. doi: 10.1007/BF00591150.
    1. Laine S, Rantala A, Gullichsen R, Ovaska J. Laparoscopic appendectomy: is it worthwhile? A prospective, randomized study in young women. Surg Endosc. 1997;11:95–97. doi: 10.1007/s004649900305.
    1. Varela JE, Hinojosa MW, Nguyen NT. Laparoscopy should be the approach of choice for acute appendicitis in morbidly obese. Am J Surg. 2008;196:218–222. doi: 10.1016/j.amjsurg.2007.08.067.
    1. Jaffer U, Cameron AE. Laparoscopic appendectomy: a junior trainee’s learning curve. JSLS. 2008;12:288–291.
    1. Nakhamiyayev V, Galldin L, Chiarello M, Lumba A, Gorecki PJ. Laparoscopic appendectomy is the preferred approach for appendicitis: a retrospective review of two practice patterns. Surg Endosc. 2010;24:859–864. doi: 10.1007/s00464-009-0678-x.
    1. Bennett J, Boddy A, Rhodes M. Choice of approach for appendicectomy: a meta-analysis of open versus laparoscopic appendicectomy. Surg Laparosc Endosc Percutan Tech. 2007;17:245–255. doi: 10.1097/SLE.0b013e318058a117.
    1. Li X, Zhang J, Sang L, Zhang W, Chu Z, Li X, Liu Y. Laparoscopic versus conventional appendectomy - a meta-analysis of randomized controlled trials. BMC Gastroenterol. 2010;10:129. doi: 10.1186/1471-230X-10-129.
    1. Sauerland S, Lefering R, Neugebauer E. Laparoscopic versus open surgery for suspected appendicitis (review) Cochrane Database Syst Rev. 2004;4:CD001546.
    1. Gupta R, Sample C, Bamehriz F, Birch DW. Infectious complications following laparoscopic appendectomy. Can J Surg. 2006;49:397–400.
    1. Katkhouda N, Friedlander MH, Grant SW, Achanta KK, Essani R, Paik P, Velmahos G, Campos G, Mason R, Mavor E. Intraabdominal abscess rate after laparoscopic appendectomy. Am J Surg. 2000;180:456–461. doi: 10.1016/S0002-9610(00)00504-3.
    1. Cueto J, D’Allemagne B, Vázquez-Frias JA, Gomez S, Delgado F, Trullenque L, Fajardo R, Valencia S, Poggi L, Ballì J, Diaz J, González R, Mansur JH, Franklin ME. Morbidity of laparoscopic surgery for complicated appendicitis: an international study. Surg Endosc. 2006;20:717–720. doi: 10.1007/s00464-005-0402-4.
    1. Vernon AH, Georgeson KE, Harmon CM. Pediatric laparoscopic appendectomy for acute appendicitis. Surg Endosc. 2004;18:75–79. doi: 10.1007/s00464-002-8868-9.
    1. Lintula H, Kokki H, Vanamo K. Single blind randomized clinical trial of laparoscopic versus open appendicectomy in children. Br J Surg. 2001;88:510–514. doi: 10.1046/j.1365-2168.2001.01723.x.
    1. Kurtz RJ, Heimann TM. Comparison of open and laparoscopic treatment of acute appendicitis. Am J Surg. 2001;182:211–214. doi: 10.1016/S0002-9610(01)00694-8.
    1. Martin LC, Puente I, Sosa JL, Bassin A, Breslaw R, McKenney MG, Ginzburg E, Sleeman D. Open versus laparoscopic appendectomy: a prespective randomized comparison. Ann Surg. 1995;222:256–262. doi: 10.1097/00000658-199509000-00004.
    1. Hansen JB, Smithers BM, Schache D, Wall DR, Miller BJ, Menzies BL. Laparoscopic versus open appendectomy: prospective randomized trial. Wolrd J Surg. 1996;20:17–21.
    1. Williams MD, Collins JN, Wright TF, Fenoglio ME. Laparoscopic versus open appendectomy. South Med J. 1996;89:668–674. doi: 10.1097/00007611-199607000-00004.
    1. Macarulla E, Vallet J, Abad JM, Hussein H, Fernandez E, Nieto B. Laparoscopic versus open appendectomy: a prospective randomized trial. Surg Laparosc Endosc. 1997;7:335–339. doi: 10.1097/00019509-199708000-00016.
    1. Minné L, Varner D, Burnell A, Ratzer E, Clark J, Haun W. Laparoscopic versus open appendectomy: a prospective randomized study of outcomes. Arch Surg. 1997;132:708–711. doi: 10.1001/archsurg.1997.01430310022003.
    1. Heikkinen TJ, Haukipuro K, Hulkko A. Cost-effective appendectomy: open or laparoscopic? A prospective randomized study. Surg Endosc. 1998;12:1204–1208. doi: 10.1007/s004649900821.
    1. Long KH, Bannon MP, Zietlow SP, Helgeson ER, Harmsen WS, Smith CD, Ilstrup DM, Baerga-Varela Y, Sarr MG. Laparoscopic Appendectomy Interest Group. A prospective randomized comparison of laparoscopic appendectomy with open appendectomy: clinical and economic analyses. Surgery. 2001;129:390–400. doi: 10.1067/msy.2001.114216.
    1. Wei HB, Huang JL, Zheng ZH, Wei B, Zheng F, Qiu WS, Guo WP, Chen TF, Wang TB. Laparoscopic versus open appendectomy: a prospective randomized comparison. Surg Endosc. 2010;24:266–269. doi: 10.1007/s00464-009-0563-7.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다