A systematic review on the cost evaluation of two different laparoscopic surgical techniques among 996 appendectomies from a single center

Zorzetti, Noemi; Lauro, Augusto; Vaccari, Samuele; Ussia, Alessandro; Brighi, Manuela; D’Andrea, Vito; Cervellera, Maurizio; Tonini, Valeria

doi:10.1007/s13304-020-00817-3

Cited by 9 publications

(12 citation statements)

References 47 publications

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“…Already previously[ 38 ], we evidenced that the routine use of EL is safe in most patients affected by AA, including cases with signs of complications. Furthermore, it is a cost-effective device, even when possible additional costs secondary to the occurrence of adverse events in the post-operative course are included.…”

Section: Discussionsupporting

confidence: 61%

“…It has been demonstrated that LA is performed more frequently in high-income countries in comparison to low-income countries (67.7% vs 8.1%), with better postoperative outcomes[ 54 ]. The difference in the costs of the used surgical devices (above all stapler) represented a principal determinant for the overall economic impact of the surgical procedure in some recent reports[ 33 , 36 , 38 , 50 , 51 ], to highlight how important is the cost-effectiveness in the measured outcomes. The medium saving reported in the present paper is relevant, varying from around approximately 300 € to more than 500 € just for the device, which then must be multiplied for the many LA conducted worldwide; further cost-analysis including operative time and LOS could reach major savings.…”

Section: Discussionmentioning

confidence: 99%

“…The routine use of EL is safe in most patients affected by AA, also when it is complicated[ 29 - 32 ], representing a cost-effective device when taking into consideration the additional costs of potential post-operative complications, too[ 33 - 37 ]. We have previously shown money saving as well as the safety of the routine use of ELs[ 38 ]. The aim of this study is to meta-analyze the international literature, to compare the outcome of the patients laparoscopically treated in Bologna via EL to the data from the international literature.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic appendectomy, stump closure and endoloops: A meta-analysis

Zorzetti¹,

Lauro²,

Bellini³

et al. 2022

World J Gastrointest Surg

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BACKGROUND Acute appendicitis (AA) is one of the main indications for urgent surgery. Laparoscopic appendectomy (LA) has shown advantages in terms of clinical results and cost-effectiveness, even if there is still controversy about different devices to utilize, especially with regards to the endoloop (EL) vs endostapler (ES) when it comes to stump closure. AIM To compare safety and cost-effectiveness of EL vs ES. METHODS From a prospectively maintained database, data of 996 consecutive patients treated by LA with a 3 years-follow up in the department of Emergency General Surgery - St Orsola University Hospital, Bologna (Italy) were retrieved. A meta-analysis was performed in terms of surgical complications, in comparison to the international literature published from 1995 to 2021. RESULTS The meta-analysis showed no evidence regarding wound infections, abdominal abscesses, and total post-operative complications, in terms of superiority of a surgical technique for the stump closure in LA. CONCLUSION Even when AA is complicated, the routine use of EL is safe in most patients.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Laparoscopic appendectomy, stump closure and endoloops: A meta-analysis

Zorzetti¹,

Lauro²,

Bellini³

et al. 2022

World J Gastrointest Surg

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“…Relatedly, the incidence of postoperative complications is a key quality metric for evaluating surgeon and hospital performance [28][29][30][31][32][33][34][35]. In over 4000 consecutive patients with acute appendicitis, the overall 90-day incidence of postoperative complications following appendectomy was 12.6%.…”

Section: Discussionmentioning

confidence: 99%

“…In over 4000 consecutive patients with acute appendicitis, the overall 90-day incidence of postoperative complications following appendectomy was 12.6%. Placing this in the context of existing literature (comprising retrospective administrative data and prospective randomized and non-randomized efficacy studies) [24][25][26][27][28][29][30][31] demonstrated divergent reporting practices as well as definitions used to identify complications. Many relevant retrospective contemporary studies reported an overall complication rate, with few defining complications in their methodology, or reporting the incidence of specific complications [24][25][26][27][28][29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Techniques for mesoappendix transection and appendix resection: insights from the ESTES SnapAppy study

Bass

Kaplan

Forssten

et al. 2023

Eur J Trauma Emerg Surg

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Introduction Surgically managed appendicitis exhibits great heterogeneity in techniques for mesoappendix transection and appendix amputation from its base. It is unclear whether a particular surgical technique provides outcome benefit or reduces complications. Material and methods We undertook a pre-specified subgroup analysis of all patients who underwent laparoscopic appendectomy at index admission during SnapAppy (ClinicalTrials.gov Registration: NCT04365491). We collected routine, anonymized observational data regarding surgical technique, patient demographics and indices of disease severity, without change to clinical care pathway or usual surgeon preference. Outcome measures of interest were the incidence of complications, unplanned reoperation, readmission, admission to the ICU, death, hospital length of stay, and procedure duration. We used Poisson regression models with robust standard errors to calculate incident rate ratios (IRRs) and 95% confidence intervals (CIs). Results Three-thousand seven hundred sixty-eight consecutive adult patients, included from 71 centers in 14 countries, were followed up from date of admission for 90 days. The mesoappendix was divided hemostatically using electrocautery in 1564(69.4%) and an energy device in 688(30.5%). The appendix was amputated by division of its base between looped ligatures in 1379(37.0%), with a stapler in 1421(38.1%) and between clips in 929(24.9%). The technique for securely dividing the appendix at its base in acutely inflamed (AAST Grade 1) appendicitis was equally divided between division between looped ligatures, clips and stapled transection. However, the technique used differed in complicated appendicitis (AAST Grade 2 +) compared with uncomplicated (Grade 1), with a shift toward transection of the appendix base by stapler (58% vs. 38%; p < 0.001). While no statistical difference in outcomes could be detected between different techniques for division of appendix base, decreased risk of any [adjusted IRR (95% CI): 0.58 (0.41–0.82), p = 0.002] and severe [adjusted IRR (95% CI): 0.33 (0.11–0.96), p = 0.045] complications could be detected when using energy devices. Conclusions Safe mesoappendix transection and appendix resection are accomplished using heterogeneous techniques. Technique selection for both mesoappendix transection and appendix resection correlates with AAST grade. Higher grade led to more ultrasonic tissue transection and stapled appendix resection. Higher AAST appendicitis grade also correlated with infection-related complication occurrence. Despite the overall well-tolerated heterogeneity of approaches to acute appendicitis, increasing disease acuity or complexity appears to encourage homogeneity of intraoperative surgical technique toward advanced adjuncts.

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