Comparison of the clinical and economic outcomes between open and minimally invasive appendectomy and colectomy: evidence from a large commercial payer database.
BACKGROUND
Appendectomy and colectomy are commonly performed surgical procedures. Despite evidence demonstrating advantages with the minimally invasive surgical (MIS) approach, open procedures occur with greater prevalence. Therefore, there is still controversy as to whether the MIS approach is safer or more cost effective.


METHODS
A retrospective analysis was performed using a large commercial payer database. The data included information on 7,532 appendectomies and 2,745 colectomies. Data on the distribution of patient demographic and comorbidity characteristics associated with the MIS and open approaches were reviewed. The corresponding complication rates and expenditures were analyzed. Summary statistics were compared using chi-square tests, and generalized linear models were constructed to estimate expenditures while controlling for patient characteristics.


RESULTS
The patients undergoing MIS and open colectomy showed no significant variations in age distribution or marginal age differences for appendectomy. Significantly more patients experienced an infection postoperatively, and procedure-specific complications were more common in the open group for both procedures (P\0.05). The postsurgical hospital stay was longer for the patients treated using the open techniques, differing an average of half a day for appendectomies and significantly more (4 days) for colectomy (P\0.05). Readmission rates differed little between the two approaches. Procedures performed through an MIS approach were associated with lower expenditures than for the open technique, with differences ranging from $700 for appendectomy patients (P\0.05) to $15,200 for colectomy patients (P\0.05).


CONCLUSIONS
Minimally invasive appendectomy and colectomy were associated with lower infection rates, fewer complications, shorter hospital stays, and lower expenditures than open surgery.
Fullum
Terrence M
TM
Howard University College of Medicine, Washington, DC, USA.
Ladapo
Joseph A
JA
Borah
Bijan J
BJ
Gunnarsson
Candace L
CL
D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000191:economics / Q000379:methods*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003082:Colectomy / Q000191:economics / Q000379:methods*; D015897:Comorbidity; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D003710:Demography; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D014481:United States / Q000453:epidemiology