Department of Surgery, York Hospital, WellSpan Health, York, Pennsylvania 17403, USA.
J Surg Res. 2011 Dec;171(2):e161-8. doi: 10.1016/j.jss.2011.06.067. Epub 2011 Jul 23.
Laparoscopic appendectomy (LA) has become more acceptable for the treatment of appendicitis over the last decade; however, its cost benefit compared to open appendectomy (OA) remains under debate. The purpose of this study is to evaluate the utilization of LA and its cost effectiveness based on total hospital charges stratified by complexity of disease and complications compared to OA.
Nationwide Inpatient Sample data from 1998 to 2008 with the principal diagnosis of appendicitis were included. Appendicitis cases were divided by simple and complex (peritonitis or abscess) and subdivided by OA, LA, and lap converted to open (CONV). Total charges (2008 value), length of stay (LOS), and complications were assessed by disease presentation and operative approach.
Between 1998 and 2008, 1,561,518 (54.3%) OA, 1,231,643 (42.8%) LA, and 84,662 (2.9%) CONV appendectomies were performed. LA had shorter LOS (2 d) than OA (3 d) and CONV (5 d) (P<0.001). CONV (7.4%) cases had more complications than OA (3.7%) and LA (2.6%). LA ($19,978) and CONV ($28,103) are costlier than OA ($15,714) based on normalized cost for simple and complex diseases (P<0.001).
LA is more prevalent but its cost is higher in both simple and complex cases. Cost and complications increase if the case is converted to open. OA remains the most cost effective approach for patients with acute appendicitis.
在过去的十年中，腹腔镜阑尾切除术（LA）已越来越被接受用于治疗阑尾炎；然而，与开腹阑尾切除术（OA）相比，其成本效益仍存在争议。本研究的目的是评估根据疾病复杂性和并发症的总住院费用，与 OA 相比，LA 的利用情况及其成本效益。
纳入了 1998 年至 2008 年全国住院患者样本中主要诊断为阑尾炎的患者。根据单纯性和复杂性（腹膜炎或脓肿）以及 OA、LA 和转为开腹（CONV）将阑尾炎病例进行分类。通过疾病表现和手术方式评估总费用（2008 年价值）、住院时间（LOS）和并发症。
1998 年至 2008 年间，行 OA 切除术 1561518 例（54.3%），LA 切除术 1231643 例（42.8%），CONV 切除术 84662 例（2.9%）。LA 的 LOS（2 天）短于 OA（3 天）和 CONV（5 天）（P<0.001）。CONV（7.4%）病例的并发症多于 OA（3.7%）和 LA（2.6%）。基于简单和复杂疾病的归一化成本，LA（19978 美元）和 CONV（28103 美元）比 OA（15714 美元）更昂贵（P<0.001）。
LA 在简单和复杂病例中更为普遍，但成本更高。如果病例转为开腹，成本和并发症会增加。OA 仍然是治疗急性阑尾炎最具成本效益的方法。
