Laparoscopic appendectomy is widely used for treatment of appendicitis, it is still unclear if it is superior to the open approach.
Dr Emanuel Sporn and colleagues from Missouri, USA evaluated the Nationwide Inpatient Sample 2000 to 2005, and hospitalizations with the primary ICD-9 procedure code of laparoscopic and open appendectomy.
Outcomes of length of stay, costs, and complications were assessed by stratified analysis for uncomplicated and complicated appendicitis (perforation or abscess).
Regression methods were used to adjust for covariates and to detect trends.
Costs were rescaled using the hospital and related services portion of the Medical Consumer Price Index.
|Frequency of laparoscopy increased from 32% to 58%|
|Journal of the American College of Surgeons|
The researchers found that between 2000 and 2005, 132,663 patients underwent open appendectomy, and 102,810 had laparoscopy.
Frequency of laparoscopy increased from 32% to 58%.
The research team noted that the conversion rates decreased from 10% to 7%.
Covariate adjusted length of stay for laparoscopy was approximately 15% shorter than for open appendectomy in both uncomplicated and complicated cases.
Adjusted costs for laparoscopy were 22% higher in uncomplicated appendicitis and 9% higher in patients with complicated appendicitis.
Costs and length of stay decreased over time in open appendectomy and laparoscopy.
The risk for a complication was higher in the laparoscopic group with uncomplicated appendicitis.
Dr Sporn’s team concluded, “Laparoscopic results in higher costs and increased morbidity for patients with uncomplicated appendicitis.”
“Nevertheless, laparoscopy is increasingly used.”
“Patients undergoing laparoscopy benefit from a slightly shorter hospital stay.”
“In general, open appendectomy may be the preferred approach for patients with acute appendicitis, with indication for laparoscopy in selected subgroups of patients.”