Can we afford to do laparoscopic appendectomy in an academic hospital?

Multiple studies have shown laparoscopic appendectomy to be safe for both acute and perforated appendicitis, but there have been conflicting reports as to whether it is superior from a cost perspective. Our academic surgical group, who perform all operative cases with resident physicians, has been c...

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Bibliographic Details
Published in:The American journal of surgery 2005-12, Vol.190 (6), p.973-977
Main Authors: Cothren, C. Clay, Moore, Ernest E., Johnson, Jeffrey L., Moore, John B., Ciesla, David J., Burch, Jon M.
Format: Article
Language:English
Subjects:
Abdomen
Academic Medical Centers - economics
Acute Disease
Adult
Antibiotics
Appendectomy
Appendectomy - economics
Appendectomy - methods
Appendicitis
Appendicitis - economics
Appendicitis - surgery
Biological and medical sciences
Cost analysis
Cost-Benefit Analysis
Digestive system. Abdomen
Education
Endoscopy
Female
General aspects
Hospital Charges
Humans
Investigative techniques, diagnostic techniques (general aspects)
Laparoscopic appendectomy
Laparoscopy - economics
Length of Stay - economics
Male
Medical imaging
Medical sciences
Mens health
Retrospective Studies
Tomography
Workforce planning
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Summary:Multiple studies have shown laparoscopic appendectomy to be safe for both acute and perforated appendicitis, but there have been conflicting reports as to whether it is superior from a cost perspective. Our academic surgical group, who perform all operative cases with resident physicians, has been challenged to reduce expenses in this era of cost containment. We recognize resident training is an expensive commodity that is poorly reimbursed, and hypothesized laparoscopic appendectomy was too expensive to justify resident teaching of this procedure. The purpose of this study was to determine if laparoscopic appendectomy is more expensive than open appendectomy. From April 2003 to April 2004, all patients undergoing appendectomy for presumed acute appendicitis at our university-affiliated teaching hospital were reviewed; demographic data, equipment charge, minutes in the operating room (OR), hospital length of stay, and total hospital charge were analyzed. OR minute charges were gradated based on equipment use and level of skilled nursing care. Conversions to open appendectomy were included in the laparoscopic group for analysis. During the study period, 247 patients underwent appendectomy for preoperative diagnosis of acute appendicitis, with 152 open (113 inflamed, 37 perforated, 2 normal), 88 laparoscopic (69 inflamed, 12 perforated, 7 normal), and 7 converted (2 inflamed, 4 perforated, 1 normal) operations performed. The majority were men (67%) with a mean age of 31.4 ± 2.2 years. Overall, there was significant difference ( P < .05) in intraoperative equipment charge ($125.32 ± $3.99 open versus $1,078.70 ± $24.06 lap), operative time charge ($3,022.16 ± $57.51 versus $4,065.24 ± $122.64), and total hospital charge ($12,310 ± $772 versus $16,773 ± $1,319) but no significant difference in operative minutes (56.3 ± 1.3 versus 57.4 ± 2.3), operating room minutes (90.5 ± 1.7 versus 95.7 ± 2.5), or hospital days (2.6 versus 2.2). In subgroup analysis of patients with uncomplicated appendicitis, open and laparoscopic groups had equivalent hospital days (1.47 versus 1.49) but significantly different hospital charges ($9,632.44 versus $14,251.07). Although operative time was similar between the 2 groups, operative and total hospital charges were significantly higher in the laparoscopic group. Unless patient factors warrant a laparoscopic approach (questionable diagnosis, obesity), we submit open appendectomy remains the most cost-effective procedure in a teachin
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2005.08.026