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

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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.

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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.

Author information

Authors and Affiliations

  1. Trauma and Emergency Center, China Medical University Hospital, Taichung 404, Taiwan

    Chun-Chieh Yeh

  2. Graduate Institute of Clinical Medical Science, China Medical University, Taichung 404, Taiwan

    Chun-Chieh Yeh

  3. Trauma and Emergency Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan

    Shih-Chi Wu & Chi-Hsun Hsieh

  4. Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan

    Chien-Chang Liao & Li-Ting Su

  5. Department of Anesthesiology, Taipei Medical University Hospital, Taipei 110, Taiwan

    Chien-Chang Liao

  6. Institute of Environmental Health, College of Public Health, China Medical University, Taichung 404, Taiwan

    Chien-Chang Liao & Li-Ting Su

  7. Graduate Institute of Biostatistics, College of Public Health, China Medical University, 91 Hsueh-Shih Road 15F, Taichung 404, Taiwan

    Tsai-Chung Li

  8. Graduate Institute of Chinese Medicine Science, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan

    Tsai-Chung Li

  9. Biostatistics Center, China Medical University, Taichung 404, Taiwan

    Tsai-Chung Li

  10. Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan

    Tsai-Chung Li

  11. Institute of Health Care Administration, College of Health Science, Asia University, Taichung 404, Taiwan

    Tsai-Chung Li

Authors
  1. Chun-Chieh Yeh
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  2. Shih-Chi Wu
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  3. Chien-Chang Liao
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  4. Li-Ting Su
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  5. Chi-Hsun Hsieh
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  6. Tsai-Chung Li
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Corresponding author

Correspondence to Tsai-Chung Li.

Appendices

Appendix A

(See Table 4)

Table 4 Inclusion criteria
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Appendix B

(See Table 5)

Table 5 ICD-9-CM codes for readmission due to postoperative complication
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Appendix C

(See Table 6)

Table 6 ICD-9-CM codes for comorbidity listed in the study
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Yeh, CC., Wu, SC., Liao, CC. et al. Laparoscopic appendectomy for acute appendicitis is more favorable for patients with comorbidities, the elderly, and those with complicated appendicitis: a nationwide population-based study. Surg Endosc 25, 2932–2942 (2011). https://doi.org/10.1007/s00464-011-1645-x

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  • DOI: https://doi.org/10.1007/s00464-011-1645-x

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