title: A cost and outcome analysis of pediatric single-incision appendectomy.
abstract: For appendicitis, single-incision laparoscopic appendectomy (SIA) has been proposed as an alternative to 3-port appendectomy (3PA). However, there remains controversy regarding outcomes and cost of SIA. We sought to review our experience with these two techniques to identify differences in these factors.
  
  
  
  The charts of children (0-17 y) who underwent appendectomy at a tertiary pediatric hospital from 2011-2014 were retrospectively reviewed. Appendectomy was either performed through traditional 3PA or SIA (laparoscopically assisted via externalization through an umbilical incision). Demographic data including age, body mass index, comorbidities, and gender were examined. Information on perforation, operative time and cost, length of stay, and infectious complications for both SIA and 3PA was identified. Data were analyzed using student t tests and chi square analysis.
  
  
  
  A total of 337 patients underwent appendectomy (141 SIA and 197 3PA), 35.6% of whom (40 SIA, 80 3PA) had perforated appendicitis. For nonperforated appendicitis, SIA had significantly shorter operative times, decreased operative costs, and length of stay. However, these differences were not found for perforated appendicitis. Regardless of appendicitis severity, there was no difference in rates of wound infection, abscess, or readmission between the two techniques.
  
  
  
  Our study suggests that SIA is a faster, more cost effective alternative than 3PA for acute appendicitis. SIA did not result in increased infection rates for acute or perforated appendicitis and can be considered an equivalent alternative to 3PA in the surgical management of appendicitis.
authors.affiliation: Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health Science University, Portland, Oregon.
authors.forename: Minna M
authors.initials: MM
authors.lastname: Wieck
authors.affiliation: Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health Science University, Portland, Oregon.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Hamilton
authors.affiliation: Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health Science University, Portland, Oregon. Electronic address: krishnas@ohsu.edu.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Krishnaswami
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000191:economics / Q000379:methods*; D001064:Appendicitis / Q000191:economics / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000191:economics / Q000209:etiology; D016896:Treatment Outcome
keywords: Appendicitis; Cost analysis; Single port; Three-port appendectomy