Treating Appendicitis by Laparoscopic Surgery Probably Not Cost-Effective

A new study suggests that a traditional (open) appendectomy may be preferable to a less-invasive laparoscopic approach for the majority of patients with acute appendicitis, contrary to recent trends.

Researchers at the University of Missouri (UMKC; Kansas City, USA) conducted a retrospective study that 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 (169,094 cases) and complicated (66,379 cases) appendicitis. Regression methods were used to adjust for covariates and to detect trends.

The study results demonstrated that the odds of having any kind of complication were significantly higher in the laparoscopic group among patients with uncomplicated appendicitis, and that there was no difference among patients with complicated appendicitis. 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% higher in uncomplicated appendicitis and 9% higher in patients with complicated appendicitis; this increased expense for laparoscopic appendectomy is 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. The study was published in the February 2009 issue of the Journal of the American College of Surgeons.

"The results of this study challenge the current trend toward increased use of laparoscopic appendectomy,” said lead author Klaus Thaler, M.D., of the department of surgery. "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.”

Appendicitis is the spreading inflammation of the inner lining of the vermiform appendix, and may occur for several reasons, such as an infection of the appendix, but the most important first step is usually due to the obstruction of the appendiceal lumen. A gangrenous, perforated appendix with or without periappendicular abscess, peritonitis, and appendicular mass are the accepted features of complicated appendicitis.

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