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Surgical Endoscopy

, 25:2932 | Cite as

Laparoscopic appendectomy for acute appendicitis is more favorable for patients with comorbidities, the elderly, and those with complicated appendicitis: a nationwide population-based study

  • Chun-Chieh Yeh
  • Shih-Chi Wu
  • Chien-Chang Liao
  • Li-Ting Su
  • Chi-Hsun Hsieh
  • Tsai-Chung LiEmail author
Article

Abstract

Background

Laparoscopic appendectomy (LA) is not routinely performed for appendicitis because the costs associated with that procedure are higher than those for open appendectomy (OA). However, few studies have investigated the economic influence of LA and OA on specific subpopulations including the elderly, patients with comorbidities, and patients with complicated appendicitis. This population-based study was designed to investigate determinants of costs and hospital length of stay (LOS) for patients undergoing appendectomy. Furthermore, the differences in costs and LOS were compared between LA and OA for various subpopulations.

Methods

Inpatients who underwent LA or OA for appendicitis during the period 2001–2008 were identified from claims data obtained from Taiwan’s National Health Insurance program. Costs and LOS were evaluated by multiple linear regression models for various subpopulations stratified according to age, number of comorbidities, and severity of appendicitis.

Results

Between 2001 and 2008, 22,252 patients (13.3%) underwent LA and 14,4438 (86.7%) had OA. Age, comorbidity, and severity of appendicitis were determinants of costs and LOS for both LA and OA. Although the costs and LOS for appendectomy increased with age and number of comorbidities, a sharper increase was noted for OA patients. Laparoscopic appendectomy mildly decreased LOS at the expense of significantly higher costs for young patients, those without comorbidities, and patients with uncomplicated appendicitis. In contrast, compared with OA, LA was associated with comparable costs and reduced LOS for the elderly, patients with comorbidities, and those with complicated appendicitis. In addition, hospital mortality and readmission rates for postoperative complications did not differ significantly between LA and OA.

Conclusion

Considering costs and LOS, patients older than 65 years, patients with comorbidities, and patients with complicated appendicitis benefit more from the laparoscopic approach for the treatment of appendicitis.

Keywords

Comorbidity Complicated appendicitis Cost Elderly Laparoscopic appendectomy Length of stay 

Notes

Acknowledgments

This study was supported by the National Sciences Council, Executive Yuan (grant numbers NSC 99-2621-M-039-001), China Medical University Hospital (grant number 1MS1), Taiwan Department of Health Clinical Trial and Research Center for Excellence (grant number DOH100-TD-B-111-004) and Taiwan Department of Health Cancer Research Center of Excellence (DOH100-TD-C-111-005).

Disclosures

Chun-Chieh Yeh, Shih-Chi Wu, Chien-Chang Liao, Li-Ting Su, Chi-Hsun Hsieh, and Tsai-Chung Li have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Ohmann C, Franke C, Kraemer M, Yang Q (2002) Status report on epidemiology of acute appendicitis. Chirurg 73:769–776PubMedCrossRefGoogle Scholar
  2. 2.
    Semm K (1983) Endoscopic appendectomy. Endoscopy 15:59–64PubMedCrossRefGoogle Scholar
  3. 3.
    Varela JE, Hinojosa MW, Nguyen NT (2008) Laparoscopy should be the approach of choice for acute appendicitis in the morbidly obese. Am J Surg 196:218–222PubMedCrossRefGoogle Scholar
  4. 4.
    Garbarino S, Shimi SM (2009) Routine diagnostic laparoscopy reduces the rate of unnecessary appendicectomies in young women. Surg Endosc 23:527–533PubMedCrossRefGoogle Scholar
  5. 5.
    Schroder DM, Lathrop JC, Lloyd LR, Boccaccio JE, Hawasli A (1993) Laparoscopic appendectomy for acute appendicitis: is there really any benefit? Am Surg 59:541–547 discussion 7–8PubMedGoogle Scholar
  6. 6.
    Vallina VL, Velasco JM, McCulloch CS (1993) Laparoscopic versus conventional appendectomy. Ann Surg 218:685–692PubMedCrossRefGoogle Scholar
  7. 7.
    Kurtz RJ, Heimann TM (2001) Comparison of open and laparoscopic treatment of acute appendicitis. Am J Surg 182:211–214PubMedCrossRefGoogle Scholar
  8. 8.
    Marzouk M, Khater M, Elsadek M, Abdelmoghny A (2003) Laparoscopic versus open appendectomy: a prospective comparative study of 227 patients. Surg Endosc 17:721–724PubMedCrossRefGoogle Scholar
  9. 9.
    Wei HB, Huang JL, Zheng ZH, Wei B, Zheng F, Qiu WS, Guo WP, Chen TF, Wang TB (2010) Laparoscopic versus open appendectomy: a prospective randomized comparison. Surg Endosc 24:266–269PubMedCrossRefGoogle Scholar
  10. 10.
    Sporn E, Petroski GF, Mancini GJ, Astudillo JA, Miedema BW, Thaler K (2009) Laparoscopic appendectomy: is it worth the cost? Trend analysis in the U.S. from 2000 to 2005. J Am Coll Surg 208:179e2–185e2CrossRefGoogle Scholar
  11. 11.
    Long KH, Bannon MP, Zietlow SP, Helgeson ER, Harmsen WS, Smith CD, Ilstrup DM, Baerga-Varela Y, Sarr MG (2001) A prospective randomized comparison of laparoscopic appendectomy with open appendectomy: clinical and economic analyses. Surgery 129:390–400PubMedGoogle Scholar
  12. 12.
    Johnson AB, Peetz ME (1998) Laparoscopic appendectomy is an acceptable alternative for the treatment of perforated appendicitis. Surg Endosc 12:940–943PubMedCrossRefGoogle Scholar
  13. 13.
    Harrell AG, Lincourt AE, Novitsky YW, Rosen MJ, Kuwada TS, Kercher KW, Sing RF, Heniford BT (2006) Advantages of laparoscopic appendectomy in the elderly. Am Surg 72:474–480PubMedGoogle Scholar
  14. 14.
    Cothren CC, Moore EE, Johnson JL, Moore JB, Ciesla DJ, Burch JM (2005) Can we afford to do laparoscopic appendectomy in an academic hospital? Am J Surg 190:950–954PubMedGoogle Scholar
  15. 15.
    Chiang TL (1997) Taiwan’s 1995 health care reform. Health Policy 39:225–239PubMedCrossRefGoogle Scholar
  16. 16.
    Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619PubMedCrossRefGoogle Scholar
  17. 17.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRefGoogle Scholar
  18. 18.
    Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925PubMedGoogle Scholar
  19. 19.
    Paranjape C, Dalia S, Pan J, Horattas M (2007) Appendicitis in the elderly: a change in the laparoscopic era. Surg Endosc 21:777–781PubMedCrossRefGoogle Scholar
  20. 20.
    Kirshtein B, Perry ZH, Mizrahi S, Lantsberg L (2009) Value of laparoscopic appendectomy in the elderly patient. World J Surg 33:918–922PubMedCrossRefGoogle Scholar
  21. 21.
    Guller U, Jain N, Peterson ED, Muhlbaier LH, Eubanks S, Pietrobon R (2004) Laparoscopic appendectomy in the elderly. Surgery 135:479–488PubMedCrossRefGoogle Scholar
  22. 22.
    Marudanayagam R, Williams GT, Rees BI (2006) Review of the pathological results of 2, 660 appendicectomy specimens. J Gastroenterol 41:745–749PubMedCrossRefGoogle Scholar
  23. 23.
    Lau WY, Fan ST, Yiu TF, Chu KW, Lee JM (1985) Acute appendicitis in the elderly. Surg Gynecol Obstet 161:157–160PubMedGoogle Scholar
  24. 24.
    Podnos YD, Jimenez JC, Wilson SE (2002) Intraabdominal sepsis in elderly persons. Clin Infect Dis 35:62–68PubMedCrossRefGoogle Scholar
  25. 25.
    Reddy K, Yusuf S (1998) Emerging epidemic of cardiovascular disease in developing countries. Circulation 97:596PubMedGoogle Scholar
  26. 26.
    Zimmet P (2000) Globalization, coca-colonization, and the chronic disease epidemic: can the Doomsday scenario be averted? J Intern Med 247:301–310PubMedCrossRefGoogle Scholar
  27. 27.
    Yau KK, Siu WT, Tang CN, Yang GP, Li MK (2007) Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg 205:60–65PubMedCrossRefGoogle Scholar
  28. 28.
    Pedersen AG, Petersen OB, Wara P, Ronning H, Qvist N, Laurberg S (2001) Randomized clinical trial of laparoscopic versus open appendicectomy. Br J Surg 88:200–205PubMedCrossRefGoogle Scholar
  29. 29.
    Martin LC, Puente I, Sosa JL, Bassin A, Breslaw R, McKenney MG, Ginzburg E, Sleeman D (1995) Open versus laparoscopic appendectomy: a prospective randomized comparison. Ann Surg 222:256–261 discussion 61–62PubMedCrossRefGoogle Scholar
  30. 30.
    Buckley RC, Hall TJ, Muakkassa FF, Anglin B, Rhodes RS, Scott-Conner CE (1994) Laparoscopic appendectomy: is it worth it? Am Surg 60:30–34PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Chun-Chieh Yeh
    • 1
    • 2
  • Shih-Chi Wu
    • 3
  • Chien-Chang Liao
    • 4
    • 5
    • 6
  • Li-Ting Su
    • 4
    • 6
  • Chi-Hsun Hsieh
    • 3
  • Tsai-Chung Li
    • 7
    • 8
    • 9
    • 10
    • 11
    Email author
  1. 1.Trauma and Emergency Center, China Medical University HospitalTaichung 404Taiwan
  2. 2.Graduate Institute of Clinical Medical ScienceChina Medical UniversityTaichung 404Taiwan
  3. 3.Trauma and Emergency Center, China Medical University HospitalChina Medical UniversityTaichung 404Taiwan
  4. 4.Management Office for Health DataChina Medical University HospitalTaichung 404Taiwan
  5. 5.Department of AnesthesiologyTaipei Medical University HospitalTaipei 110Taiwan
  6. 6.Institute of Environmental Health, College of Public HealthChina Medical UniversityTaichung 404Taiwan
  7. 7.Graduate Institute of Biostatistics, College of Public HealthChina Medical UniversityTaichung 404Taiwan
  8. 8.Graduate Institute of Chinese Medicine Science, College of Chinese MedicineChina Medical UniversityTaichung 404Taiwan
  9. 9.Biostatistics CenterChina Medical UniversityTaichung 404Taiwan
  10. 10.Department of Medical ResearchChina Medical University HospitalTaichung 404Taiwan
  11. 11.Institute of Health Care Administration, College of Health ScienceAsia UniversityTaichung 404Taiwan

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