title: Laparoscopic versus open appendectomy: a retrospective cohort study assessing outcomes and cost-effectiveness.
abstract: BACKGROUND
  Appendectomy is the most common surgical procedure performed in emergency surgery. Because of lack of consensus about the most appropriate technique, appendectomy is still being performed by both open (OA) and laparoscopic (LA) methods. In this retrospective analysis, we aimed to compare the laparoscopic approach and the conventional technique in the treatment of acute appendicitis.
  
  
  METHODS
  Retrospectively collected data from 593 consecutive patients with acute appendicitis were studied. These comprised 310 patients who underwent conventional appendectomy and 283 patients treated laparoscopically. The two groups were compared for operative time, length of hospital stay, postoperative pain, complication rate, return to normal activity and cost.
  
  
  RESULTS
  Laparoscopic appendectomy was associated with a shorter hospital stay (2.7 ± 2.5 days in LA and 1.4 ± 0.6 days in OA), with a less need for analgesia and with a faster return to daily activities (11.5 ± 3.1 days in LA and 16.1 ± 3.3 in OA). Operative time was significantly shorter in the open group (31.36 ± 11.13 min in OA and 54.9 ± 14.2 in LA). Total number of complications was less in the LA group with a significantly lower incidence of wound infection (1.4 % vs 10.6 %, P <0.001). The total cost of treatment was higher by 150 € in the laparoscopic group.
  
  
  CONCLUSIONS
  The laparoscopic approach is a safe and efficient operative procedure in appendectomy and it provides clinically beneficial advantages over open method (including shorter hospital stay, decreased need for postoperative analgesia, early food tolerance, earlier return to work, lower rate of wound infection) against only marginally higher hospital costs.
  
  
  BACKGROUND
  NCT02867072 Registered 10 August 2016. Retrospectively registered.
authors: Department of Surgery, Vittorio Emanuele Hospital, University of Catania, Via Plebiscito, 628, 95124 Catania, Italy.
authors: Antonio
authors: A
authors: Biondi
authors: General and Emergency Surgery Department, Garibaldi Hospital, 95100 Catania, Italy.
authors: Carla
authors: C
authors: Di Stefano
authors: General and Emergency Surgery Department, Garibaldi Hospital, 95100 Catania, Italy.
authors: Francesco
authors: F
authors: Ferrara
authors: General and Emergency Surgery Department, Garibaldi Hospital, 95100 Catania, Italy.
authors: Angelo
authors: A
authors: Bellia
authors: Department of Medical and Pediatric Sciences, University of Catania, 95125 Catania, Italy.
authors: Marco
authors: M
authors: Vacante
authors: General and Emergency Surgery Department, Garibaldi Hospital, 95100 Catania, Italy.
authors: Luigi
authors: L
authors: Piazza
keywords: Appendicitis; Hospital cost; Laparoscopic appendectomy; Open appendectomy