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Similar Outcomes at a Lower Cost: An Argument for Open Appendectomy in Simple Appendicitis
*Erin M Garvey, *Turner Osler, James C Hebert
University of Vermont College of Medicine, Burlington, VT
OBJECTIVE: To examine the differences in clinical outcomes and financial costs between open and laparoscopic appendectomies for simple appendicitis.
DESIGN: Retrospective study.
SETTING: A university-affiliated tertiary referral center.
PATIENTS: A total of 324 consecutive nonpregnant, adult patients who underwent open (OA) or laparoscopic appendectomy (LA) for acute appendicitis between January 1, 2007, and December 31, 2008.
MAIN OUTCOME MEASURES: Wound infection, intra-abdominal abscess, operative time, pain scores, time until first meal, postoperative length of stay (LOS) and total hospital charges.
RESULTS: 250 (77.2%) patients were classified as having simple appendicitis. 177 (70.8%) underwent OA and 73 (29.2%) underwent LA. For simple appendicitis, the LA group had a higher BMI (28 vs 26, p < 0.022), longer operative time (56 vs 47 minutes, p < 0.001) and higher total hospital charges ($16,727 vs $12,840, p < 0.001). There was no significant difference between OA and LA for wound infection, intra-abdominal abscess, pain scores, time to first meal or postoperative LOS.
CONCLUSIONS: In the case of simple appendicitis, LA offers no benefit over OA with respect to wound infection, intra-abdominal abscess, pain scores, time until first meal or postoperative LOS. The total hospital charges for LA were substantially more than for OA.
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