Laparoscopic appendectomy for acute appendicitis is more favorable for patients with comorbidities, the elderly, and those with complicated appendicitis: a nationwide population-based study

Abstract

Laparoscopic appendectomy (LA) is not routinely performed for appendicitis because the costs associated with that procedure are higher than those for open appendectomy (OA). However, few studies have investigated the economic influence of LA and OA on specific subpopulations including the elderly, patients with comorbidities, and patients with complicated appendicitis. This population-based study was designed to investigate determinants of costs and hospital length of stay (LOS) for patients undergoing appendectomy. Furthermore, the differences in costs and LOS were compared between LA and OA for various subpopulations. Inpatients who underwent LA or OA for appendicitis during the period 2001-2008 were identified from claims data obtained from Taiwan's National Health Insurance program. Costs and LOS were evaluated by multiple linear regression models for various subpopulations stratified according to age, number of comorbidities, and severity of appendicitis. Between 2001 and 2008, 22,252 patients (13.3%) underwent LA and 14,4438 (86.7%) had OA. Age, comorbidity, and severity of appendicitis were determinants of costs and LOS for both LA and OA. Although the costs and LOS for appendectomy increased with age and number of comorbidities, a sharper increase was noted for OA patients. Laparoscopic appendectomy mildly decreased LOS at the expense of significantly higher costs for young patients, those without comorbidities, and patients with uncomplicated appendicitis. In contrast, compared with OA, LA was associated with comparable costs and reduced LOS for the elderly, patients with comorbidities, and those with complicated appendicitis. In addition, hospital mortality and readmission rates for postoperative complications did not differ significantly between LA and OA. Considering costs and LOS, patients older than 65years, patients with comorbidities, and patients with complicated appendicitis benefit more from the laparoscopic approach for the treatment of appendicitis.