title: Transumbilical laparoscopic-assisted appendectomy is associated with lower costs compared to multiport laparoscopic appendectomy.
abstract: OBJECTIVE
  Single-incision laparoscopic appendectomy has been associated with improved cosmetic benefits, and decreased postoperative pain. Less is known about costs and other outcomes. Our aim was to evaluate the costs and outcomes between transumbilical laparoscopic-assisted appendectomy (TULAA) and multiport laparoscopic appendectomy (MLA).
  
  
  METHODS
  IRB-approved retrospective review (September 2010-July 2013) of institutional medical records identified 372 pediatric patients undergoing laparoscopic appendectomy. Outcomes included costs, LOS and readmission. Costs were fully loaded operating costs from the hospital's cost accounting database. Generalized linear regression was used to assess costs of MLA and TULAA. A subgroup analysis was performed using only patients with non-perforated appendicitis.
  
  
  RESULTS
  There were 132 patients (35.5%) that underwent TULAA while 240 patients (65.5%) underwent MLA. Compared to MLA, TULAA was associated with decreased operative time (0.6 vs. 1.0h, p<0.0001), used in comparable proportions of interval appendectomies, but was performed less often for perforated appendicitis (9.8% vs. 22.9%, p=0.002). Readmission and postoperative complications were similar between both groups. In the setting of non-perforated appendicitis, TULAA was associated with lower costs of $1378 relative to MLA (p=0.009).
  
  
  CONCLUSIONS
  In non-perforated appendicitis, TULAA is associated with lower costs and comparable rates of readmission and postoperative complications.
authors.affiliation: Division of Pediatric Surgery, Penn State Hershey Medical Center; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine.
authors.forename: Afif N
authors.initials: AN
authors.lastname: Kulaylat
authors.affiliation: Division of Pediatric Surgery, Penn State Hershey Medical Center.
authors.forename: Abigail B
authors.initials: AB
authors.lastname: Podany
authors.affiliation: Department of Public Health Sciences, The Pennsylvania State University, College of Medicine.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.affiliation: Division of Pediatric Surgery, Penn State Hershey Medical Center.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Santos
authors.affiliation: Division of Pediatric Surgery, Penn State Hershey Medical Center. Electronic address: drocourt@hmc.psu.edu.
authors.forename: Dorothy V
authors.initials: DV
authors.lastname: Rocourt
mesh_terms: D001062:Appendectomy / Q000191:economics* / Q000379:methods; D001064:Appendicitis / Q000191:economics / Q000601:surgery*; D002648:Child; D005260:Female; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D007902:Length of Stay / Q000191:economics; D008297:Male; D010359:Patient Readmission / Q000191:economics; D012189:Retrospective Studies; D014472:Umbilicus / Q000601:surgery
keywords: Appendectomy; Costs; Laparoscopic-assisted; Single-site