title: Economics of appendicitis: cost trend analysis of laparoscopic versus open appendectomy from 1998 to 2008.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, York Hospital, WellSpan Health, York, Pennsylvania 17403, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: McGrath
authors.forename: Michelle T
authors.initials: MT
authors.lastname: Buckius
authors.forename: Rod
authors.initials: R
authors.lastname: Grim
authors.forename: Theodore
authors.initials: T
authors.lastname: Bell
authors.forename: Vanita
authors.initials: V
authors.lastname: Ahuja
mesh_terms: D000328:Adult; D001064:Appendicitis / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D015995:Prevalence; D014481:United States / Q000453:epidemiology