What is the Operative Cost of Managing Acute Appendicitis in the NHS: The Impact of Stump Technique and Perioperative Imaging

摘要

Background Acute appendicitis is a common surgical emergency that is typically managed with laparoscopic appendicectomy in UK centres. A number of variables influence the cost of managing this condition. Our aim was to identify the major influencing factors in our centre by performing a cumulative cost analysis. Methods We retrospectively analysed the costs associated with 99 cases of acute appendicitis managed with laparoscopic appendicectomy at Ninewells Hospital, Dundee, from January 2014 to February 2016. Costs were categorised according to blood tests, imaging, medications, operative costs and length of stay. Results Our cohort included 66 males, 33 females and 28 paediatric cases. The total cost was 220030.52 pound with a mean of 2222.53 pound per patient. The factor with the greatest influence on overall cost was operative time (53.2%) followed by length of stay (39.2%). There was no cost difference between adults and children (p = 0.24) or males and females (p = 0.38). Mean cost in adults >= 50 years was greater than those <50 years (2899.32 pound vs 2152.97 pound, p = 0.008) and greater in those who underwent imaging as opposed to no imaging (2789.53 pound vs 2010.65 pound, p = 0.0001). For appendiceal stump technique, polymer clips were cheaper (1844.70) pound than ligatures (2380.11 pound, p = 0.006). Conclusions Operative time (53.2%) and length of stay (39.2%) had the greatest impact on the cost in our cohort. Older patients have a greater overall cost, and this is associated with increased utilisation of imaging. Further studies assessing the safety and feasibility of methods to reduce operative time and to investigate the safety of reducing length of stay are required.