Laparoscopic Appendectomy: A Report on 1164 Operations at a Single-Institution, Safety-Net Hospital

Dumas, Ryan P.; Subramanian, Madhu; Hodgman, Erica I.; Arevalo, Michelle K.; Nguyen, Gabriella; Li, Kevin; Aijwe, Tochi; Williams, Brian H.; Eastman, Alexander L.; Luk, Stephen S.; Minshall, Christian T.; Cripps, Michael W.

doi:10.1177/000313481808400674

Cited by 13 publications

(12 citation statements)

References 34 publications

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“…Rates of negative appendectomy have decreased significantly secondary to the high diagnostic accuracy of modern diagnostic imaging. 35,45–47 These results may not be applicable to low-resource settings where preoperative diagnostic imaging is less frequently utilized and rates of negative appendectomy are higher.…”

Section: Discussionmentioning

confidence: 99%

“…We assumed that all appendectomies were completed laparoscopically, in line with modern case series describing very low rates of conversion to open appendectomy for uncomplicated appendicitis. 34–37 We assumed that all NOM failures or recurrences underwent laparoscopic appendectomy (i.e., no further attempts at NOM were made). All patients with complicated failures or recurrences were assumed to undergo percutaneous drain placement by interventional radiology followed by interval appendectomy.…”

Section: Methodsmentioning

confidence: 99%

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Operative Versus Nonoperative Management of Appendicitis: A Long-Term Cost Effectiveness Analysis

Sceats

Coughran

et al. 2019

MDM Policy & Practice

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Background. Recent clinical trials suggest that nonoperative management (NOM) of patients with acute, uncomplicated appendicitis is an acceptable alternative to surgery. However, limited data exist comparing the long-term cost-effectiveness of nonoperative treatment strategies. Design. We constructed a Markov model comparing the cost-effectiveness of three treatment strategies for uncomplicated appendicitis: 1) laparoscopic appendectomy, 2) inpatient NOM, and 3) outpatient NOM. The model assessed lifetime costs and outcomes from a third-party payer perspective. The preferred strategy was the one yielding the greatest utility without exceeding a $50,000 willingness-to-pay threshold. Results. Outpatient NOM cost $233,700 over a lifetime; laparoscopic appendectomy cost $2500 more while inpatient NOM cost $7300 more. Outpatient NOM generated 24.9270 quality-adjusted life-years (QALYs), while laparoscopic appendectomy and inpatient NOM yielded 0.0709 and 0.0005 additional QALYs, respectively. Laparoscopic appendectomy was cost-effective compared with outpatient NOM (incremental cost-effectiveness ratio $32,300 per QALY gained); inpatient NOM was dominated by laparoscopic appendectomy. In one-way sensitivity analyses, the preferred strategy changed when varying perioperative mortality, probability of appendiceal malignancy or recurrent appendicitis after NOM, probability of a complicated recurrence, and appendectomy cost. A two-way sensitivity analysis showed that the rates of NOM failure and appendicitis recurrence described in randomized trials exceeded the values required for NOM to be preferred. Limitations. There are limited NOM data to generate long-term model probabilities. Health state utilities were often drawn from single studies and may significantly influence model outcomes. Conclusion. Laparoscopic appendectomy is a cost-effective treatment for acute uncomplicated appendicitis over a lifetime time horizon. Inpatient NOM was never the preferred strategy in the scenarios considered here. These results emphasize the importance of considering long-term costs and outcomes when evaluating NOM.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Operative Versus Nonoperative Management of Appendicitis: A Long-Term Cost Effectiveness Analysis

Sceats

Coughran

et al. 2019

MDM Policy & Practice

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“…The length of stay in the LA group was significantly shorter. Most of the published comparative series, meta-analyses and reviews also show a statistically significant shorter length of stay when compared with the open appendectomy [12,26,[39][40][41][42][43][44][45].…”

Section: Discussionmentioning

confidence: 99%

Complications after Laparoscopic Appendectomy for Complicated Appendicitis

Nikolovski¹,

Tahir²,

Mladenovikj³

2020

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Background. Laparoscopic appendectomy is established method in the treatment of complicated appendicitis. Certain advantages of the technique do not fulfill the expectations for its superiority over the open appendectomy as when it is used for uncomplicated appendicitis. This is generally caused because of the high variety of postoperative complications reported in different series for complicated appendicitis. Material and methods. This prospective interventional clinical study analyzes 61 patients operated with laparoscopic and open appendectomy due to complicated appendicitis, with an end point of comparing the intra and postoperative complications in both groups. Results. Conversion in open appendectomy was forced in one patient (1.63%). The operative time was significantly shorter in the laparoscopic group (p = 0.048). Wound infection was significantly predominant in the open group (p = 0.045). Postoperative intraabdominal abscess occurred in one patient in the laparoscopic group (p = 0.52). The overall morbidity was 26.2% (7 patients in the laparoscopic, and 9 in the open group; p = 0.59). Length of stay was significantly shorter in the laparoscopic group (p = 0.00001). Conclusion. Certain significant advantages of the laparoscopic appendectomy as low incidence of wound infection, short hospitalization, less postoperative pain and faster socialization makes the laparoscopy up to date method in the treatment of complicated appendicitis.

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“…Although nonoperative management of acute appendicitis has been shown to be a viable option for some patients [1], appendectomy is still considered the standard treatment by most surgeons and laparoscopy is the preferred approach [2, 17, 21]. The diagnostic pathway of RLQ pain has dramatically changed during the past decade in many countries including the USA.…”

Section: Discussionmentioning

confidence: 99%

Development of a Two Port Laparoscopic Appendectomy Technique at a Rural Hospital

Bonatti

2019

Minimally Invasive Surgery

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Background. Laparoscopic appendectomy (LA) is most commonly performed using two 5-mm and one 10/12-mm ports. Various attempts to reduce the number and size of ports have been made and new technologies such as single port LA have been introduced. Appendix and mesoappendix are usually divided with a stapler or energy device with electrocautery, clips, and endoloop being cheaper options. Patients and Methods. This study includes 51 consecutive LAs performed at a rural hospital. Patients were divided into 4 groups: group 1 was the standard technique group (n=12), group 2 served as a “try-out” (n=12), group 3 served as feasibility group (n=12), and group 4 was the final patient cohort in which the optimized technique was preferably used (n=15). Results. Median age of the study cohort was 35.4 (range: 6.2-80.6) years, and 55% of patients were male. Whereas in G1 all patients had standard port placement (10/12-mm, 2x5-mm), in an increasing number of patients in G2-4 only two 5-mm ports and the 2.3-mm Teleflex minigrasper were inserted. Usage of staplers and/or energy devices was reduced from 100% in G1 to 20% in G4, and in the majority of cases both the appendix and the vascular pedicle were secured with an endoloop. The new technique did not add time to the procedure or total OR time. No stump-leaks or surgical site infections were encountered in this series, and there were no conversions to open surgery. Cost savings when not using a stapler or energy device are approximately 400$ per case; the minigrasper added approximately 200$ to the case. Discussion. LA with use of two ports and a portless needle grasper is feasible in the majority of cases and was associated with high patient satisfaction and excellent cosmetic results. Avoiding energy devices and staplers is cost saving; the endoloop securely controls appendix and mesoappendix.

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Laparoscopic Appendectomy: A Report on 1164 Operations at a Single-Institution, Safety-Net Hospital

Cited by 13 publications

References 34 publications

Operative Versus Nonoperative Management of Appendicitis: A Long-Term Cost Effectiveness Analysis

Operative Versus Nonoperative Management of Appendicitis: A Long-Term Cost Effectiveness Analysis

Complications after Laparoscopic Appendectomy for Complicated Appendicitis

Development of a Two Port Laparoscopic Appendectomy Technique at a Rural Hospital

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