• Vol. 43 No. 9, 464–468
  • 15 September 2014

Clinical Outcome and Cost Comparison Between Laparoscopic and Open Appendicectomy

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ABSTRACT

Introduction: Local data comparing laparoscopic appendicectomy (LA) and open appendicectomy (OA) is lacking. We perform a cost and outcome comparison between LA and OA.

Materials and Methods: A retrospective review of all appendicectomies performed for suspected appendicitis from July 2010 to December 2010 was conducted. Patient demographics, duration of surgery, complication rates, total cost of stay (COS) and length of stay (LOS) were compared between LA and OA.

Results: A total of 198 patients underwent appendicectomy during the duration of study; 82 LA and 116 OA. There were 115 males (58.1%) and 83 females (41.9%). Median age was 33 years. Patients who underwent LA were significantly younger (P <0.001) with a greater proportion of females (P <0.0001) and were more likely to be negative appendicectomies (18.3% vs. 6.9%, P = 0.023). Duration of surgery was significantly longer in LA patients (86 min vs. 74 min, P = 0.003). LOS in the LA group was shorter by 1.3 days compared to OA (2.0 days vs. 3.3 days, P <0.0001). The differences in operative duration and LOS between LA and OA remained significant on multivariate analysis (P = 0.001 and P = 0.008, respectively). The COS (P = 0.359), wound infection rates (P = 0.528) and complication rates (P = 0.131) were not significantly different between the 2 groups.

Conclusion: LA is associated with a shorter LOS while its cost is equivalent to OA. From the perspective of utilisation of healthcare resources, LA appears to be superior.


Acute appendicitis is one of the most common causes of acute abdominal pain requiring surgical intervention. The traditional operation of choice was the open appendicectomy (OA) pioneered by McBurney in 1894. In 1981, the laparoscopic technique was introduced by Kurt Semm and since then, laparoscopic appendicectomy (LA) is increasingly being performed in place of OA. While there is an abundance of published data comparing the pros and cons of LA and OA from overseas, local data is lacking. To the best of our knowledge, there has only been one local publication specifically comparing outcomes between LA and OA. However, this paper was published close to 20 years ago when LA was still a relatively new procedure. In particular, there is no data comparing the cost difference between LA and OA in the local context. This is important as cost analysis from foreign publications may not be applicable in our local setting as healthcare economics vary between countries. In the current era where healthcare resources are spread thinly nationwide, such data is crucial for us to determine the more cost-effective technique for the treatment of a common surgical pathology. We thus aim to perform a cost analysis and compare the clinical outcomes between LA and OA in the local setting.

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