A CLINICAL OUTCOME AND COST-ANALYSIS OF LAPAROSCOPIC VERSUS OPEN APPENDECTOMY

BACKGROUND: Benefits of laparoscopic appendectomy are controversial, a nd the results of recent clinical studies have contradictory conclusio ns. We performed a cost analysis comparing laparoscopic and open appen dectomies to assess potential efficacy of the laparoscopic approach. M ETHODS: All patients operated on for suspected acute appendicitis at t he University of Washington Medical Center (UWMC) from January 1, 1991 through January 1, 1995 were analyzed. Potential benefits of the lapa roscopic approach were examined in five major categories: hospital len gth of stay, total hospital charges, operative time, operating room ch arges, and postoperative complications, Patients were stratified accor ding to the presence or absence of perforation for outcome analysis. R ESULTS: There were 163 appendectomies performed in 82 men and 81 women , Twenty-seven (17%) patients had laparoscopic evaluation, of which 21 underwent attempted laparoscopic appendectomy. Among nonperforated pa tients, laparoscopic appendectomy did not reduce hospital stay compare d with open appendectomy, but did lead to greater hospital charges ($7 760 vs $5064; P < 0.001). Operating times were longer in the laparosco pic group (104 vs 74 minutes; P ( 0.001) compared with open appendecto mies. Operating room charges for laparoscopic appendectomies exceeded charges for the open approach ($4740 vs $1870; P < 0.001), Complicatio n rates were similar (laparoscopic, 19% vs open, 16%; NS). The false d iagnostic rate for women was four times greater than for men among pat ients undergoing open appendectomy (31% vs 8%; P < 0.01), Patients wit h perforation undergoing a midline incision had a longer hospital slay (9.5 vs 5.9; P < 0.02) than patients operated on through a right lowe r quadrant incision. CONCLUSIONS: In our analysis, laparoscopic append ectomy, while safe, was more expensive and was not associated with bet ter clinical outcome compared with open appendectomy patients.