« Back to Document View

Databases selected: Career and Technical Education

Laparoscopic Surgery For Appendicitis May Not Be Worth The Cost

Alicia R Borst. JAAPA : Journal of the American Academy of Physician Assistants. Montvale: Dec
2007. Vol. 20, Iss. 12; pg. 36, 4 pgs

Abstract (Summary)
New research published in the February issue of the Journal of the American College of
Surgeons suggests that a traditional, "open" appendectomy may be preferable to a less-invasive
laparoscopic appendectomy for the majority of patients with acute appendicitis, contrary to recent trends.
"The results of this study challenge the current trend toward increased use of laparoscopic
appendectomy," said Klaus Thaler, MD, FACS, department of surgery, University of Missouri, Kansas
City. "Although laparoscopic surgery is associated with shorter hospital stays, it actually increases costs
and may raise the risk of complications in the majority of appendectomy patients."

Full Text (1081 words)

Copyright Haymarket Media, Inc. Dec 2007

[Headnote]

New research published in the February issue of the Journal of the American College of
Surgeons suggests that a traditional, "open" appendectomy may be preferable to a less-invasive
laparoscopic appendectomy for the majority of patients with acute appendicitis, contrary to recent trends.

Approximately 250,000 appendectomies are performed in the United States each year to treat
appendicitis, an inflammation of the appendix that is considered a medical emergency. If treatment is
delayed, the appendix can rupture, causing infection and even death.

For almost a century, open appendectomy was the standard treatment for appendicitis, until the 1980s
when laparoscopic appendectomy first gained popularity. This transition was based on data that
suggested the operation, in which an instrument called a laparoscope is inserted through small incisions
in the abdomen, was associated with reduced pain, faster recovery and better cosmetic results.

"The results of this study challenge the current trend toward increased use of laparoscopic
appendectomy," said Klaus Thaler, MD, FACS, department of surgery, University of Missouri, Kansas
City. "Although laparoscopic surgery is associated with shorter hospital stays, it actually increases costs
and may raise the risk of complications in the majority of appendectomy patients."

This retrospective study examined 235,473 patients who underwent open or laparoscopic appendectomy
between 2000 and 2005. Length-of-stay, costs and complications were assessed by stratified analysis for
uncomplicated (n=169,094) and complicated (n=66,379) appendicitis. Regression methods were used to
adjust for covariates and to detect trends.

The study demonstrated that the odds of having any kind of complication were significantly higher in the
laparoscopic group among patients with uncomplicated appendicitis (p<0.05, odds ratio = 1.07), and that
there was no difference among patients with complicated appendicitis (p=0.74). The only complications
reduced by using the laparoscopic approach were infections in the uncomplicated group, and infections
and pulmonary complications in the complicated group.

The adjusted costs for laparoscopic appendectomy were 22 percent higher in uncomplicated appendicitis
and 9 percent higher in patients with complicated appendicitis (p<0.001). The increased expense for
laparoscopic appendectomy are likely related to higher operating room costs, including greater expense
for operative instruments and longer operative times. According to the study, laparoscopic appendectomy
did result in a reduced length of hospital stay for both the uncomplicated and complicated groups
(p<0.001 and p<0.0001, respectively).

[Author Affiliation]
Alicia R. Borst, PA-C

[Author Affiliation]
Alicia Borst is a PA in surgery with the Department of Surgery, University of South Carolina School of Medicine,
Columbia, South Carolina. She has indicated no relationships to disclose relating to the content of this article.

Indexing (document details)

Subjects: Mortality, Studies, Medical diagnosis, Appendicitis, Pregnancy
MeSH subjects: Appendectomy -- methods (major), Appendicitis -- diagnosis (major), Appendicitis --
surgery, Diagnosis, Differential, Emergency Treatment (major), Female, Humans,
Laparoscopy, Laparotomy, Perinatal Care (major), Pregnancy, Pregnancy Outcome
(major)
Author(s): Alicia R Borst
Author Affiliation: Alicia R. Borst, PA-C

Alicia Borst is a PA in surgery with the Department of Surgery, University of South

Carolina School of Medicine, Columbia, South Carolina. She has indicated no
relationships to disclose relating to the content of this article.
Document features: Photographs, Tables, References
Section: REVIEW ARTICLE
Publication title: JAAPA : Journal of the American Academy of Physician Assistants. Montvale: Dec
2007. Vol. 20, Iss. 12; pg. 36, 4 pgs
Source type: Periodical
ISSN: 15471896
ProQuest document ID: 1857885881
Text Word Count 2891
Document URL: http://proquest.umi.com/pqdweb?did=1857885881&sid=19&Fmt=3&c
lientId=98602&RQT=309&VName=PQD

Copyright © 2010 ProQuest LLC. All rights reserved. Terms and Conditions
Text-only interface