title: Cost of open versus laparoscopic appendectomy.
abstract: OBJECTIVE
  There are several literatures on outcome variations between patients treated with an open appendectomy (OA) and a laparoscopic appendectomy (LA). However, there are no studies assessing differences in cost and outcome that adjust for age and hospital function or region. This study examines the differences in cost and procedure-related complications of OA and LA procedures.
  
  
  METHODS
  This study contains 1703 appendectomy patients treated for appendicitis in 76 academic hospitals and 80 community hospitals. Demographic variables, clinical variables, length of stay (LOS), total charges (TC; US$) and complication rates were analyzed for both OA and LA procedures. The specific contributions of LA to LOS, TC, and complication rate were identified using multivariate analysis.
  
  
  RESULTS
  1469 (86.3%) patients underwent OA and 234 (13.7%) underwent LA. Complicated appendicitis was diagnosed in 13.1% of OA cases and 15.4% of LA cases. The complication rates were 3.4% in OA and 2.6% in LA (p=0.504). There were significant differences in LOS and TC by severity of appendicitis and by procedure type. After risk adjustment for the other study variables, LA was associated with a higher TC than OA ($1458, p0.001). However there were no significant differences in LOS or complication rates between the two treatment groups.
  
  
  CONCLUSIONS
  This study suggests that LA increases cost, but has no significant impact on LOS or complication rates. However, other outcomes such as quality of life or subgroup analysis for obese patients are needed for a more complete economic analysis of OA and LA.
authors.affiliation: Kyushu University, Graduate School of Medical Sciences, Department of Health Care Administration and Management, Kyushu University. kazu228@basil.ocn.ne.jp
authors.forename: K
authors.initials: K
authors.lastname: Kuwabara
authors.forename: Y
authors.initials: Y
authors.lastname: Imanaka
authors.forename: S
authors.initials: S
authors.lastname: Matsuda
authors.forename: K
authors.initials: K
authors.lastname: Fushimi
authors.forename: H
authors.initials: H
authors.lastname: Hashimoto
authors.forename: K B
authors.initials: KB
authors.lastname: Ishikawa
authors.forename: H
authors.initials: H
authors.lastname: Horiguchi
authors.forename: K
authors.initials: K
authors.lastname: Hayashida
authors.forename: K
authors.initials: K
authors.lastname: Fujimor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000191:economics* / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D055815:Young Adult