Laparoscopic Appendectomies: Does Technique Matter?

T J Hufford, BA, Ronald Markart, PhD, Jonathan M Saxe, MD. Wright State University


Cost for health care has become an increasing concern for health care providers and hospitals. Even seemingly routine procedures can impact the cost of care in a appreciable manner. In our large community hospital we noticed two consistent ways of performing laparoscopic appendectomy. The first methods utilized the endostapler and endocatch bag to remove the appendix, and the second method employed the harmonic scalpel and an endoloop. The purpose of this retrospective study was to evaluate the differences in both outcome and cost in the two techniques.
Methods: A retrospective chart review for a period of 6 months from January 2011 to July 2011 identified 114 eligible patients (n = 81 for endostapler; n = 33 for endoloop). Data collected included clinical data: age, race, sex, co-morbid factors, BMI, pathology, and post operative complications as well as non-fixed financial data: charges for OR time, disposables. Statistical analysis was performed utilizing the Students T-test with Bonferonni correction and the Chi-Square analysis where appropriate. IRB approval was obtained prior to data collection.
Results: The two methods did not differ on abscess (endoloop = 12%, endostapler = 9%, p = .73), return for complications (12% vs. 17%, p = .49), and length of stay following surgery (41 hrs vs. 51 hrs, p = .37). The endoloop method was less costly for both total operative charges ($16,126 vs. $11,699) and operating room charges ($10,798 vs. $14,172). The endoloop method also required less total operative time (43 minutes vs. 60 minutes) and less operating room time (71 minutes vs. 93 minutes). [all comparisons p < .001] The mean savings per patient were $4,427 and $3,374 for total operative and operating room charges, respectively. The lower cost for the endoloop method was due to less total operative and operating room time, 17 minutes and 22 minutes, respectively.
Conclusion: endoloop and endostapler methods do not differ in clinical outcomes, but the endoloop is notably less costly.


Session Number: Poster – Poster Presentations
Program Number: P113
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