Cost analysis of laparoscopic appendectomy in a large integrated healthcare system

Malhotra, Lavina; Pontarelli, Elizabeth M.; Grinberg, Gary G.; Isaacs, Richard S.; Morris, James; Yenumula, Pandu

doi:10.1007/s00464-020-08266-0

Cited by 11 publications

(10 citation statements)

References 15 publications

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“…This is associated with device malfunction and improper decontamination, and is therefore discouraged. 12…”

Section: Resultsmentioning

confidence: 99%

“…7 They are associated with an increased surgical time in some centers, where the endoloop is not the norm. 3,12 This is likely due to a reported increased need for surgical experience in the deployment of an endoloop. 3 Where there is a greater propensity to use the endoloop, operative time is significantly reduced in comparison to both staplers and clips.…”

Section: Appendiceal Stump Closurementioning

confidence: 99%

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In Pursuit of the Most Cost-Effective Laparoscopic Appendicectomy: A Review of the Literature

2023

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Purpose To review the literature and identify the most economical techniques for laparoscopic appendicectomy (LA) that do not compromise on patient care. Methods We performed a search of the Cochrane Library, PubMed, EMBASE and Google Scholar for papers published between January 2001 and January 2021. The outcomes of the included studies were then grouped by theme of cost analysis, with the main areas of focus being the use of disposable equipment, appendiceal stump closure, and retrieval of the appendix. Results After screening a total of 254 search results, 40 studies were included, representing 13 285 patient outcomes, having two main areas of focus: the use of reusable or disposable equipment and the different methods of appendiceal stump closure. Use of disposable instruments has been cost effective in LA in 2 studies. However, use of reusable trocars has reduced cost of procedure by €250 in another study. Appendiceal stump closure using ligature, endoloops or Endoclips had been cost-effective compared to Endostaplers in 25 studies. This can save up to €350. Endoscopic specimen bags are single use and represent further disposable equipment costs. The use of a sterile glove to replace this piece of kit can further provide cost benefit as shown in 2 studies. Conclusion Laparoscopic appendicectomy can be performed in a variety of ways with equivocal patient safety. We present the use of extracorporeal ligature of the appendiceal base, combined with the use of a surgical glove retrieval system as the most economic technique in laparoscopic appendicectomy.

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“…This is associated with device malfunction and improper decontamination, and is therefore discouraged. 12…”

Section: Resultsmentioning

confidence: 99%

Section: Appendiceal Stump Closurementioning

confidence: 99%

In Pursuit of the Most Cost-Effective Laparoscopic Appendicectomy: A Review of the Literature

2023

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“…Therefore, polymeric clips are not only safe and effective for perforated and nonperforated appendicitis, but they are also cost-effective. Moreover, a recent study reports that polymeric clip choice as an alternative to endoloops or staplers does not prolong operation and hospitalization time [ 48 ]. It could be an option to reduce the price of laparoscopic appendectomy.…”

Section: Discussionmentioning

confidence: 99%

Self-Locking Polymeric Clips Are Safe for the Closure of Appendiceal Stump in Laparoscopic Appendectomy

et al. 2023

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Background: Closure of the appendix stump is critical to avoid serious postoperative complications. There are a number of options, but the best one has not been identified yet. The purpose of this study is to evaluate the outcomes of appendiceal stump closure using self-locking polymeric clips and endoloops. Methods: A retrospective analysis of the prospectively maintained database of patients with acute appendicitis was performed. Patient demographic details and surgical characteristics, including the duration of hospital stay, postoperative complications, and also the cost of the appendix stump closure, were recorded. Patients were divided into two groups according to the appendix stump closure method: the clips group if it was closed with self-locking polymeric clips and the loops group if Vicryl or PDS loops were used. Statistical analysis was performed using Pearson’s chi-squared test, Wilcoxon rank sum (Mann–Whitney U) test, and Fisher’s exact test in R statistical software package version 4.2.1. Results: 515 patients were included in the study from June 2016 to April 2021. There were no significant differences in terms of demographics (p-value in comparison of groups’ sex > 0.99, age p-value 0.16), postoperative complications (p-value > 0.99), histological findings (p-value 0.27), or length of hospital stays (p-value 0.18) between the two patient groups (clips group, N = 454 and loops group, N = 61). The price of operation while using different appendiceal stump closures is significantly different. In a laparoscopic appendectomy, one stump closure with self-locking clips costs 7.69 €, with Vicryl loops—91.35 €, with PDS loops—96.51 €, and with a stapler—514.50 €. Conclusions: Self-locking polymeric clips can be used for the safe and effective closure of an appendiceal stump. There were no significant differences in the postoperative time (30 days) or complication rates among patients in both (clips and loops) groups. Thus, this might be a technique to reduce expenses while maintaining good postoperative results after laparoscopic appendectomy.

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“…With an increase in the cost of health care in recent years, there has been a push toward outpatient surgery with the intent to decrease the length of hospital stay and other related costs. Global estimates suggest that the incidence of appendicitis/appendectomy is high (around 100 to 200 per 100,000 person-years) and the cost per appendectomy is also substantial (6,(8)(9)(10). Therefore, a significant reduction in health care expense due to SDD along with no increased readmission risk, unplanned visits to emergency, and other complications may provide more impetus for its adoption in routine clinical care.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, another study using the Dutch healthcare reimbursement registry showed that appendicitis along with appendectomy contributes to a substantial clinical and economic burden (8). While surgery remains the gold standard for management, there is a substantial risk of complications and a notable financial burden associated with appendicectomy (8)(9)(10). Some of the documented risks of appendicectomy include wound infection, post-operative ileus and intra-abdominal abscess.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Same-Day Discharge After Appendectomy in Pediatric Patients: A Systematic Review and Meta-Analysis

Zheng

2022

Front. Pediatr.

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BackgroundTo compare the readmission rate, rate of urgent/unplanned visits to emergency, complication rate along with cost of health care among children and adolescents who were discharged the same day following a laparoscopic appendectomy and those who were not discharged on the same day.MethodsA systematic search was performed in the PubMed, Embase, and Scopus databases. Randomized controlled trials and studies, observational in design, were considered for inclusion. The included studies were conducted in children and adolescents with uncomplicated appendicitis undergoing laparoscopic appendectomy and compared outcomes of interest between patients that were discharged the same day (SDD group) following the operation and patients that were discharged within 2 days post-operatively (non-SSD group). Statistical analysis was performed using STATA software. Effect sizes were reported as pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence intervals.ResultsA total of 13 studies with 32,021 children and adolescents were included. There was no significant difference in the risks of unplanned visit to the emergency department (OR 1.07, 95% CI: 0.78, 1.47), readmission (OR 0.83, 95% CI: 0.66, 1.05), reoperation/re-intervention (OR 1.73, 95% CI: 0.19, 16.2) and complications (OR 0.84, 95% CI: 0.67, 1.06) in both groups of patients. Patients in the SDD group had slightly lower risk of wound infection/complication (OR 0.74, 95% CI: 0.57, 0.96) compared to patients in the non-SDD group. Those with SDD had to incur comparatively lesser hospital expense (in USD) compared to those with no SDD (WMD −2587.4, 95% CI: −4628.3, −546.6).ConclusionIn children and adolescents with uncomplicated acute appendicitis undergoing laparoscopic appendectomy, same-day discharge is not associated with increased readmission risk, unplanned visits to emergency, and complications. Further, SDD is associated with lower cost of hospital care. Adoption of SDD in this subset of children and adolescents may be encouraged.Systematic Review Registration[www.crd.york.ac.uk/prospero], identifier [CRD420 22320539].

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Cost analysis of laparoscopic appendectomy in a large integrated healthcare system

Cited by 11 publications

References 15 publications

In Pursuit of the Most Cost-Effective Laparoscopic Appendicectomy: A Review of the Literature

In Pursuit of the Most Cost-Effective Laparoscopic Appendicectomy: A Review of the Literature

Self-Locking Polymeric Clips Are Safe for the Closure of Appendiceal Stump in Laparoscopic Appendectomy

Feasibility of Same-Day Discharge After Appendectomy in Pediatric Patients: A Systematic Review and Meta-Analysis

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