title: Laparoscopic versus open appendectomy in children: the effect of surgical technique on healthcare costs.
abstract: BACKGROUND
  Reducing healthcare costs while maintaining quality of care is one of the challenges of the current healthcare system. The purpose of this study was to compare the hospital charges accrued following laparoscopic (LA) and open (OA) appendectomies in the pediatric population.
  
  
  METHODS
  We retrospectively reviewed all pediatric appendectomies (n = 264) performed from 2007 to 2013 at a single academic center. Subgroup analysis on charges and costs was performed on perforated and nonperforated LA and OA.
  
  
  RESULTS
  A total of 195 (73.9%) appendectomies were performed laparoscopically. LA in both perforated and nonperforated groups was associated with higher surgical supply, operating room, and total hospital charges compared with OA. Surgical supply costs to the facility were higher by an average of $1,000 for both nonperforated and perforated appendicitis in the LA group. Length of stay and postoperative complications were comparable within all groups.
  
  
  CONCLUSIONS
  In this study, LA is associated with significantly higher surgical costs and charges than OA without improvement in outcomes. Investigation into cost reduction strategies of laparoscopy should be a component of future clinical appendicitis research.
authors: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: mmichai2@jhmi.edu.
authors: Maria
authors: M
authors: Michailidou
authors: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Seth D
authors: SD
authors: Goldstein
authors: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Maria G
authors: MG
authors: Sacco Casamassima
authors: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Jose H
authors: JH
authors: Salazar
authors: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Robert
authors: R
authors: Elliott
authors: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: John
authors: J
authors: Hundt
authors: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Fizan
authors: F
authors: Abdullah
mesh_terms: D001062:Appendectomy / Q000191:economics* / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D005260:Female; D017048:Health Care Costs; D006801:Humans; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies
keywords: Costs; Laparoscopy; Pediatric appendicitis; Surgical technique