Comparison of the clinical and economic outcomes between open and minimally invasive appendectomy and colectomy: Evidence from a large commercial payer database

Terrence M. Fullum, Joseph A. Ladapo, Bijan J Borah, Candace L. Gunnarsson

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: Appendectomy and colectomy are commonly performed surgical procedures. Despite evidence demonstrating advantages with the minimally invasive surgical (MIS) approach, open procedures occur with greater prevalence. Therefore, there is still controversy as to whether the MIS approach is safer or more cost effective. Methods A retrospective analysis was performed using a large commercial payer database. The data included information on 7,532 appendectomies and 2,745 colectomies. Data on the distribution of patient demographic and comorbidity characteristics associated with the MIS and open approaches were reviewed. The corresponding complication rates and expenditures were analyzed. Summary statistics were compared using chi-square tests, and generalized linear models were constructed to estimate expenditures while controlling for patient characteristics. Results The patients undergoing MIS and open colectomy showed no significant variations in age distribution or marginal age differences for appendectomy. Significantly more patients experienced an infection postoperatively, and procedure-specific complications were more common in the open group for both procedures (P<0.05). The postsurgical hospital stay was longer for the patients treated using the open techniques, differing an average of half a day for appendectomies and significantly more (4 days) for colectomy (P<0.05). Readmission rates differed little between the two approaches. Procedures performed through an MIS approach were associated with lower expenditures than for the open technique, with differences ranging from $700 for appendectomy patients (P<0.05) to $15,200 for colectomy patients (P<0.05). Conclusions Minimally invasive appendectomy and colectomy were associated with lower infection rates, fewer complications, shorter hospital stays, and lower expenditures than open surgery.

Original languageEnglish (US)
Pages (from-to)845-853
Number of pages9
JournalSurgical Endoscopy and Other Interventional Techniques
Volume24
Issue number4
DOIs
StatePublished - Apr 2010
Externally publishedYes

Fingerprint

Appendectomy
Colectomy
Economics
Databases
Health Expenditures
Length of Stay
Age Distribution
Chi-Square Distribution
Infection
Comorbidity
Linear Models
Demography
Costs and Cost Analysis

Keywords

  • Abdominal
  • Appendectomy
  • Colectomy
  • Economic outcomes
  • Minimally invasive
  • Minimally invasive surgery (MIS)
  • Open procedure

ASJC Scopus subject areas

  • Surgery

Cite this

Comparison of the clinical and economic outcomes between open and minimally invasive appendectomy and colectomy : Evidence from a large commercial payer database. / Fullum, Terrence M.; Ladapo, Joseph A.; Borah, Bijan J; Gunnarsson, Candace L.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 24, No. 4, 04.2010, p. 845-853.

Research output: Contribution to journalArticle

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AB - Background: Appendectomy and colectomy are commonly performed surgical procedures. Despite evidence demonstrating advantages with the minimally invasive surgical (MIS) approach, open procedures occur with greater prevalence. Therefore, there is still controversy as to whether the MIS approach is safer or more cost effective. Methods A retrospective analysis was performed using a large commercial payer database. The data included information on 7,532 appendectomies and 2,745 colectomies. Data on the distribution of patient demographic and comorbidity characteristics associated with the MIS and open approaches were reviewed. The corresponding complication rates and expenditures were analyzed. Summary statistics were compared using chi-square tests, and generalized linear models were constructed to estimate expenditures while controlling for patient characteristics. Results The patients undergoing MIS and open colectomy showed no significant variations in age distribution or marginal age differences for appendectomy. Significantly more patients experienced an infection postoperatively, and procedure-specific complications were more common in the open group for both procedures (P<0.05). The postsurgical hospital stay was longer for the patients treated using the open techniques, differing an average of half a day for appendectomies and significantly more (4 days) for colectomy (P<0.05). Readmission rates differed little between the two approaches. Procedures performed through an MIS approach were associated with lower expenditures than for the open technique, with differences ranging from $700 for appendectomy patients (P<0.05) to $15,200 for colectomy patients (P<0.05). Conclusions Minimally invasive appendectomy and colectomy were associated with lower infection rates, fewer complications, shorter hospital stays, and lower expenditures than open surgery.

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