Incidental appendectomy in the era of managed care and laparoscopy

BACKGROUND: In a study carried out before laparoscopy or managed care, ther e was no cost or patient benefit for routine incidental appendectomy. With the onset of laparoscopy, a change in indications for surgery, and increase d prevalence of capitated contracts, a reanalysis of the cost-effectiveness of incidental appendectomy is warranted. STUDY DESIGN: Financial data from 251 patients undergoing appendectomy for acute appendicitis without complication at a single institution were identi fied. Age-specific epidemiology data from the Centers for Disease Control, Atlanta, were applied to assess risk and cost of future appendectomy. The n et cost or savings for incidental appendectomies necessary to prevent one c ase of acute appendectomy was determined and stratified by gender and age t o the population as a whole. Further adjustment was made for the variable l evel of surgeon reimbursement for incidental appendectomy. RESULTS: At 10% surgeon reimbursement, open incidental appendectomy was cos t-effective in those less than 25 years of age (< 35 years of age in a capi tated system). Applied to the general population, open incidental appendect omy in those less than 25 years represented savings of up to $1,100 per 10, 000 population per year. A surgeon fee of greater than 50%, or the laparosc opic approach using staplers, accrued no savings in any age groups. CONCLUSIONS: Open incidental appendectomy at low physician reimbursement is a cost-effective procedure for patients of less than 35 years of age. A de crease in equipment cost for laparoscopic approach will extend these indica tions. (J Am Coll Surg 2001;192:182-188. (C) 2001 by the American College o f Surgeons).