A COST-EFFECTIVENESS COMPARISON OF THE OPEN AND LAPAROSCOPIC APPENDECTOMIES FOR PEDIATRIC PATIENTS

Year 2019, , 151 - 161, 13.12.2019

Amita Bhadauria , Amogh Bhatnagar

https://doi.org/10.23884/ijhsrp.2019.4.3.01

Abstract

Objectives: Laparoscopic appendectomy (LA)
is preferred to open appendectomy (OA), as it is less invasive. However, it is
debatable whether LA is more cost-effective. We compared the cost-benefits of
LA with OA, using the entire pediatric inpatient hospital data in USA.

Methods: The
Kids' Inpatient Database (KID) shows that 51,007 pediatric patients were
subjected to laparoscopic appendectomy and 12,668
to open appendectomy during 2010-12 across the
USA. This dataset was used to assess the cost-effectiveness
of LA and OA, while controlling for the
demographic characteristics of patients (e.g. age and gender), their background
(e.g., place of residence), and complexity of surgery (e.g., number of
procedures).

 Results: We found that patients with laparoscopic
surgery saved ~0.46 days of hospital stay, but paid $3641 more compared to patients
with open surgery.

Conclusions: Surgeons prefer to use the technologically
advanced laparoscopic appendectomy  (80% of
patients). Our analysis shows that the cost-benefit of laparoscopic
appendectomy is marginal.  Hence, for making
a fully informed decision, patients should be provided with both clinical and
cost comparison data.

Keywords

open appendectomy, laparoscopic appendectomy, pediatric patient, economic cost, regression, cross-sectional analysis

References

• 1. Semm, K. (1983) Endoscopic appendectomy. Endoscopy 15, 59-64
• 2. Slim, K., Pezet, D., and Chipponi, J. (1998) Laparoscopic or open appendectomy? Critical review of randomized, controlled trials. Dis Colon Rectum 41, 398-403
• 3. Garbutt, J. M., Soper, N. J., Shannon, W. D., Botero, A., and Littenberg, B. (1999) Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy. Surg Laparosc Endosc 9, 17-26
• 4. Chung, R. S., Rowland, D. Y., Li, P., and Diaz, J. (1999) A meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy. Am J Surg 177, 250-256
• 5. Temple, L. K., Litwin, D. E., and McLeod, R. S. (1999) A meta-analysis of laparoscopic versus open appendectomy in patients suspected of having acute appendicitis. Can J Surg 42, 377-383
• 6. Schirmer, B. D., Schmieg, R. E., Dix, J., Edge, S. B., and Hanks, J. B. (1993) Laparoscopic Versus Traditional Appendectomy for Suspected Appendicitis. American Journal of Surgery 165, 670-675
• 7. Yau, K. K., Siu, W. T., Tang, C. N., Yang, G. P., and Li, M. K. (2007) Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg 205, 60-65
• 8. Lee, S. L., Yaghoubian, A., and Kaji, A. (2011) Laparoscopic vs Open Appendectomy in Children Outcomes Comparison Based on Age, Sex, and Perforation Status. Arch Surg-Chicago 146, 1118-1121
• 9. Tang, E., Ortega, A. E., Anthone, G. J., and Beart, R. W. (1996) Intraabdominal abscesses following laparoscopic and open appendectomies. Surg Endosc-Ultras 10, 327-328
• 10. Golub, R., Siddiqui, F., and Pohl, D. (1998) Laparoscopic versus open appendectomy: A metaanalysis. J Am Coll Surgeons 186, 545-553
• 11. Sauerland, S., Lefering, R., and Neugebauer, E. A. (2004) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev, CD001546
• 12. Pokala, N., Sadhasivam, S., Kiran, R. P., and Parithivel, V. (2007) Complicated appendicitis - Is the laparoscopic approach appropriate? A comparative study with the open approach: outcome in a community hospital setting. Am Surgeon 73, 737-741
• 13. Lintula, H., Kokki, H., Vanamo, K., Antila, P., and Eskelinen, M. (2002) Laparoscopy in children with complicated appendicitis. Journal of Pediatric Surgery 37, 1317-1320
• 14. Wullstein, C., Barkhausen, S., and Gross, E. (2001) Results of laparoscopic vs. conventional appendectomy in complicated appendicitis. Diseases of the Colon & Rectum 44, 1700-1705
• 15. Ng, W. T., Lee, Y. K., Hui, S. K., Sze, Y. S., Chan, J., Zeng, A. G. Y., Wong, C. H., and Wong, W. H. (2004) An optimal, cost-effective laparoscopic appendectomy technique for our surgical residents. Surg Laparo Endo Per 14, 125-129
• 16. Ruiz-Patino, A., Rey, S., Molina, G., Dominguez, L. C., and Rugeles, S. (2018) Cost-effectiveness of laparoscopic versus open appendectomy in developing nations: a Colombian analysis. Journal of Surgical Research 224, 33-37
• 17. Biondi, A., Di Stefano, C., Ferrara, F., Bellia, A., Vacante, M., and Piazza, L. (2016) Laparoscopic versus open appendectomy: a retrospective cohort study assessing outcomes and cost-effectiveness. World J Emerg Surg 11
• 18. Thoma, A., Farrokhyar, F., McKnight, L., and Bhandari, M. (2010) How to optimize patient recruitment. Canadian Journal of Surgery 53, 205-210
• 19. Cadeddu, M., Farrokhyar, F., Thoma, A., Haines, T., Garnett, A., Goldsmith, C. H., and Grp, E.-B. S. W. (2008) Users' guide to the surgical literature: how to assess power and sample size. Canadian Journal of Surgery 51, 476-482
• 20. Rotter T, K. L., James E, Machotta A, Gothe H, Willis J, Snow P, Kugler J. (2010) Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev 303(21)
• 21. Cheong, L. H. A., and Emil, S. (2014) Determinants of appendicitis outcomes in Canadian children. Journal of Pediatric Surgery 49, 777-781
• 22. Al-Qurayshi, Z., Kadi, A., Srivastav, S., and Kandil, E. (2016) Risk and outcomes of 24-h delayed and weekend appendectomies. Journal of Surgical Research 203, 246-+
• 23. Tuggle, K. R., Ortega, G., Bolorunduro, O. B., Oyetunji, T. A., Alexander, R., Turner, P. L., Chang, D. C., Cornwell, E. E., 3rd, and Fullum, T. M. (2010) Laparoscopic versus open appendectomy in complicated appendicitis: a review of the NSQIP database. J Surg Res 163, 225-228
• 24. Maddala, G. S., & Lahiri, K. (1992) Introduction to econometrics (Vol. 2). New York: Macmillan
• 25. Worni, M., Ostbye, T., Gandhi, M., Rajgor, D., Shah, J., Shah, A., Pietrobon, R., Jacobs, D. O., and Guller, U. (2012) Laparoscopic appendectomy outcomes on the weekend and during the week are no different: a national study of 151,774 patients. World J Surg 36, 1527-1533
• 26. Kiviluoto, T., Siren, J., Luukkonen, P., and Kivilaakso, E. (1998) Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 351, 321-325
• 27. Siesto, G., Giudici, S., Seveso, A., Zefiro, F., Mellana, L., Ceravolo, G., Volpi, E., and Donadello, N. (2007) Surgicopathologic outcome of laparoscopic versus open radical hysterectomy. Int J Gynecol Can