Economic evaluation of antibiotic therapy <i>versus</i> appendicectomy for the treatment of uncomplicated acute appendicitis from the APPAC randomized clinical trial

Sippola, Suvi; Grönroos, Juha; Tuominen, Risto; Paajanen, Hannu; Rautio, Tero; Nordström, Pia; Aarnio, Markku; Rantanen, Tuomo; Hurme, Saija

doi:10.1002/bjs.10575

Cited by 76 publications

(78 citation statements)

References 28 publications

(45 reference statements)

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“…In this cohort, already the majority of cases (64%) was treated in general hospitals and, assuming equivalent outcomes, this may be further encouraged. Non-operative treatment of appendicitis has also been proposed to be an economical choice [17], at no compromise in safety according to several recent studies [11,49,50]. Patients treated non-operatively were excluded from this study, and the DBC reimbursement system does not allow for discrimination of operating costs from admission day costs.…”

Section: Discussionmentioning

confidence: 99%

“…Apart from avoiding surgery and its potential complications, non-operative treatment might also be beneficial in terms of healthcare cost savings. However, the available evidence is ambiguous [15][16][17][18]. Regarding the choice of operative approach, most studies have demonstrated comparable or better clinical outcomes for minimally invasive compared to open appendectomy, however at higher medical care costs [19][20][21][22].…”

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confidence: 99%

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Disease burden of appendectomy for appendicitis: a population-based cohort study

2019

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Background Few large-scale epidemiologic studies evaluate the clinical and economic burden of appendicitis. These data may impact future research and treatment strategies. In this study, the objective was to determine the burden of appendectomy for appendicitis in terms of incidence rates, length of hospital stay (LOS) and hospital costs on a national level. In addition, outcomes were compared for subgroups based on surgical treatment, age and hospital setting. Methods Observational retrospective population-based cohort study using the national Dutch healthcare reimbursement registry, which covers hospital registration and reimbursement for 17 million inhabitants. Patients with a diagnosis of appendicitis who underwent appendectomy between 2006 and 2016 were included. Primary outcomes were incidence rates, LOS and hospital costs. Results A total of 135,025 patients were included. Some 53% of patients was male, and 64% was treated in a general hospital. The overall incidence rate of appendectomy was 81 per 100,000 inhabitants and showed a significant decreasing trend across time and age. Mean ± SD LOS per patient was 3.66 ± 3.5 days. LOS showed a significant increase with age and was significantly longer for open versus minimally invasive appendectomy. Mean ± SD hospital costs per patient were €3700 ± 1284. Costs were initially lower for open compared to minimally invasive appendectomy, but were similar from 2012 onward. Compared to non-university hospitals, patients treated in university hospitals had a significantly longer LOS and higher costs. Conclusions Appendectomy for appendicitis represents a substantial clinical and economic burden in the Netherlands. A preference for minimally invasive technique seems justified. Keywords Appendicitis • Appendectomy • Length of stay • Hospital costs Although acute appendicitis is highly prevalent among adults and children worldwide, literature on the clinical and economic burden of the disease is scarce. Emergent appendectomy remains the cornerstone of treatment and is nowadays mostly performed via the minimally invasive approach in Western countries [1-3]. It is known as a low-risk surgical procedure, with reported mortality rates between 0.03 and 0.24% [4-6]. Depending on the intraoperative classification, patients may be discharged within 24-48 h, or after a few days of prolonged antibiotic prophylaxis [7, 8]. Infectious complications occur in some 9-20% of patients, accompanied by a hospital readmission rate of 6% [5, 9]. Whereas morbidity and mortality are estimators of the burden of

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Disease burden of appendectomy for appendicitis: a population-based cohort study

2019

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“…Approximately 25% of acute appendicitis cases present as complicated acute appendicitis [33]. Increasing evidence from randomized trials suggests that the majority of patients with uncomplicated acute appendicitis can be treated safely with antibiotics with low tumor rates avoiding unnecessary surgery resulting in decreased morbidity and cost savings [1,3,6]. The markedly lower tumor rate associated with uncomplicated acute appendicitis is of vital clinical importance as non-operative management of uncomplicated appendicitis is one its way of becoming one of the treatment options for uncomplicated acute appendicitis [1,3,34] as the appendiceal tumors are not generally suspected preoperatively [30,35].…”

Section: Discussionmentioning

confidence: 99%

“…Uncomplicated acute appendicitis may also resolve spontaneously without even antibiotics, let alone surgery [5]. Non-operative management of uncomplicated acute appendicitis has also been shown to reduce treatment costs [6]. In cases of complicated acute appendicitis with a formation of a circumscribed abscess, the need for interval appendectomy after initial successful conservative treatment has also been questioned as the risk of appendicitis recurrence is quite low between 5 and 20% [7].…”

Section: Introductionmentioning

confidence: 99%

Appendiceal neoplasm risk associated with complicated acute appendicitis—a population based study

Lietzén

Grönroos

Mecklin∥

et al. 2018

Int J Colorectal Dis

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Purpose Appendiceal tumors are rare, but high neoplasm rates have been reported at interval appendectomy after periappendicular abscess. Non-operative management of uncomplicated acute appendicitis has shown promising results. The data on appendiceal tumor incidence and presentation among acute appendicitis patients is limited, especially in patient cohorts differentiating between uncomplicated and complicated acute appendicitis. Objective was to assess appendiceal tumor incidence and tumor association to appendicitis in patients with uncomplicated and complicated acute appendicitis. Methods This nationwide population-based registry study was conducted from 2007 to 2013. The Finnish Cancer Registry and the National Institute for Health Registry were used to combine data on all appendiceal tumors and acute appendicitis diagnosis with medical reports evaluated at eight study hospitals. Results Altogether, 840 appendiceal tumors were identified, and out of these, 504 patient reports were reviewed, including 472 patients in this study. Tumor was diagnosed at appendectomy for suspected acute appendicitis in 276 patients (58%). In the whole study, histologically acute appendicitis and tumor were both present in 53% (n = 250), and out of these, 41% (n = 102) were complicated and 59% (n = 148) uncomplicated acute appendicitis. The associated tumor risk was significantly higher in complicated acute appendicitis compared with uncomplicated cases (3.24% vs. 0.87%, p < 0.001). Overall tumor prevalence among acute appendicitis patients was 1.24%. Conclusions Appendiceal tumor prevalence in acute appendicitis was low. Tumor risk was significantly higher in complicated acute appendicitis compared with uncomplicated acute appendicitis. The risk of missed appendiceal tumors related to antibiotic therapy of uncomplicated acute appendicitis is very low.

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“…Gold standard treatment of acute appendicitis is the appendectomy. Today, after the development and popularization of laparoscopic interventions, appendectomy has become the preferred method in the treatment of acute appendicitis.However, appendectomy, whether open or laparoscopic, poses many risks in terms of surgery and anesthesia, like as all other surgical procedures, leading to costs, resulting in complications at certain rates [3][4][5]. In thepresent study, which is planned without criticizing the valuable place of appendectomy in the treatment of patients with acute appendicitis, it was aimed to investigate whether antibiotherapy can be preferred to the emergency surgical International Journal of Medical Science and Clinical Invention, vol.…”

Section: Introductionmentioning

confidence: 99%

Comparing Appendectomy and Conservative Treatment for Patients with Uncomplicated Acute Appendicitis

Kendirci

2018

ijmsci

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Economic evaluation of antibiotic therapy versus appendicectomy for the treatment of uncomplicated acute appendicitis from the APPAC randomized clinical trial

Abstract: Patients receiving antibiotic therapy for uncomplicated appendicitis incurred lower costs than those who had surgery.

Cited by 76 publications

References 28 publications

Disease burden of appendectomy for appendicitis: a population-based cohort study

Disease burden of appendectomy for appendicitis: a population-based cohort study

Appendiceal neoplasm risk associated with complicated acute appendicitis—a population based study

Comparing Appendectomy and Conservative Treatment for Patients with Uncomplicated Acute Appendicitis

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