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The Costs and Effects of Laparoscopic Appendectomy in Children
Hannu Lintula, MD;
Hannu Kokki, MD, PhD;
Kari Vanamo, MD, PhD;
Hannu Valtonen, PhD;
Matti Mattila, MD, PhD;
Matti Eskelinen, MD, PhD
Arch Pediatr Adolesc Med. 2004;158:34-37.
Background Laparoscopic procedures are performed commonly in children. In general, the cost containment of laparoscopic surgery in children has not been evaluated.
Objective To compare the costs of laparoscopic appendectomy with those of open appendectomy.
Design Prospective clinical trial between November 1, 1997, and April 30, 2000. For analysis, cost of supplies, operation room use, and recovery in the hospital and after discharge was evaluated. Costs common to both groups were not determined.
Setting Operations performed in a university hospital.
Patients Eighty-seven children aged 4 to 15 years who underwent appendectomy for suspected appendicitis. Patients were randomized to laparoscopic or open appendectomy.
Intervention Laparoscopic appendectomies performed with the same standard set of reusable equipment.
Main Outcome Measures Cost surplus of the laparoscopic procedure and recovery after surgery were evaluated, to determine the costs and effects of laparoscopic appendectomy compared with those of open appendectomy in children.
Results Excess operating and complication costs per procedure were 96 euros (EUR) in laparoscopic appendectomy. The increased operative expenses were offset by a shorter hospital stay, resulting in a marginal difference of 53 EUR in itemized total costs between the 2 procedures (total cost, 1023 EUR in the laparoscopic appendectomy group and 970 EUR in the open appendectomy group). After laparoscopic appendectomy, children returned to school and sports earlier than those who had had an open appendectomy.
Conclusion Laparoscopic appendectomy was marginally more expensive, but it allowed earlier return to normal daily activities than open appendectomy.
From the Departments of Paediatric Surgery (Dr Lintula), Anaesthesiology and Intensive Care (Drs Kokki and Mattila), Paediatric Surgery (Dr Vanamo), and Surgery (Dr Eskelinen), Kuopio University Hospital, and Department of Health Policy and Management, Kuopio University (Dr Valtonen), Kuopio, Finland.
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