title: Laparoscopic appendectomy for acute appendicitis is more favorable for patients with comorbidities, the elderly, and those with complicated appendicitis: a nationwide population-based study.
abstract: BACKGROUND
  Laparoscopic appendectomy (LA) is not routinely performed for appendicitis because the costs associated with that procedure are higher than those for open appendectomy (OA). However, few studies have investigated the economic influence of LA and OA on specific subpopulations including the elderly, patients with comorbidities, and patients with complicated appendicitis. This population-based study was designed to investigate determinants of costs and hospital length of stay (LOS) for patients undergoing appendectomy. Furthermore, the differences in costs and LOS were compared between LA and OA for various subpopulations.
  
  
  METHODS
  Inpatients who underwent LA or OA for appendicitis during the period 2001-2008 were identified from claims data obtained from Taiwan's National Health Insurance program. Costs and LOS were evaluated by multiple linear regression models for various subpopulations stratified according to age, number of comorbidities, and severity of appendicitis.
  
  
  RESULTS
  Between 2001 and 2008, 22,252 patients (13.3%) underwent LA and 14,4438 (86.7%) had OA. Age, comorbidity, and severity of appendicitis were determinants of costs and LOS for both LA and OA. Although the costs and LOS for appendectomy increased with age and number of comorbidities, a sharper increase was noted for OA patients. Laparoscopic appendectomy mildly decreased LOS at the expense of significantly higher costs for young patients, those without comorbidities, and patients with uncomplicated appendicitis. In contrast, compared with OA, LA was associated with comparable costs and reduced LOS for the elderly, patients with comorbidities, and those with complicated appendicitis. In addition, hospital mortality and readmission rates for postoperative complications did not differ significantly between LA and OA.
  
  
  CONCLUSIONS
  Considering costs and LOS, patients older than 65 years, patients with comorbidities, and patients with complicated appendicitis benefit more from the laparoscopic approach for the treatment of appendicitis.
authors.affiliation: Trauma and Emergency Center, China Medical University Hospital, Taichung 404, Taiwan. b8202034@gmail.com
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Yeh
authors.forename: Shih-Chi
authors.initials: SC
authors.lastname: Wu
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Liao
authors.forename: Li-Ting
authors.initials: LT
authors.lastname: Su
authors.forename: Chi-Hsun
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Tsai-Chung
authors.initials: TC
authors.lastname: Li
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D001064:Appendicitis / Q000150:complications / Q000191:economics / Q000601:surgery*; D002648:Child; D015897:Comorbidity; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007342:Insurance Benefits / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult