The cost-effectiveness of laparoscopic appendectomy.

The first 26 attempted laparoscopic appendectomies for the clinical diagnosis of acute appendicitis were compared with an age and sex matched control group of patients randomly selected from those operated on for acute appendicitis during the previous 6 month period. Both groups were comparable in terms of severity of disease, absolute white count, previous surgery, and co-morbidity. The mean operative time for the laparoscopic appendectomy group was 73 min vs 36 min for the open group (p < 0.001), but the morbidity (12% vs 38%) was significantly less (p < 0.01). The length of stay was shorter (2.8 vs 3.4 days) but this failed to achieve statistical significance. The time to full recovery was significantly (p < 0.01) shorter (11.1 vs 23.7 days). Hospital charges for laparoscopic appendectomy were higher (but not significantly) than for open appendectomy. The results of this study confirm that laparoscopic appendectomy is a safe and effective alternative to open appendectomy which results in a more rapid return to full activity but incurs higher hospital charges. The overall cost effectiveness of laparoscopic appendectomy should be even greater than that of open appendectomy.