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27.01.2021 | 2020 SAGES Poster

Cost analysis of laparoscopic appendectomy in a large integrated healthcare system

Surgical Endoscopy
Lavina Malhotra, Elizabeth M. Pontarelli, Gary G. Grinberg, Richard S. Isaacs, James P. Morris, Pandu R. Yenumula
Wichtige Hinweise
This article was updated to a correct typo in Figure 3 (the stapler only surgeon count = 205, not 295). This article was updated to correct the third sentence of the next-to-last paragraph, to read: “The idea of this study was not to account for every dollar but to look at the bigger picture of trend in the cost.” This article was updated to correct the fifth sentence of the next-to-last paragraph of the Discussion section, to read: “Nonetheless, staplers were used in 88% of cases, and SUDs in 80% with a distinct correlation to individual surgeons.”
A correction to this article is available online at https://​doi.​org/​10.​1007/​s00464-021-08356-7.

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Healthcare expenditure is on the rise placing greater emphasis on operational excellence, cost containment, and high quality of care. Significant variation is seen in operating room (OR) costs with common surgical procedures such as laparoscopic appendectomy. Surgeons can influence cost through the selection of instrumentation for common surgical procedures such as laparoscopic appendectomy. We aimed to quantify the cost of laparoscopic appendectomy in our healthcare system and compare cost variations to operative times and outcomes.

Methods and procedures

We performed a retrospective review of laparoscopic appendectomies in a large regional healthcare system during one-year period (2018). Operating room supply costs and procedure durations were obtained for each hospital. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) outcomes and demographics were compared to the costs for each hospital.


A total of 4757 laparoscopic appendectomies were performed at 20 hospitals (27 to 522 per hospital) by 233 surgeons. The average supply cost per case ranged from $650 to $1067. Individual surgeon cost ranged from $197 to $1181. The average operative time was 41 min (range 33 to 60 min). There was no association between lower cost and longer operative time. The patient demographics and comorbidities were similar between sites. There were no significant differences in postoperative complications between high- and low-cost centers. The items with the greatest increase in cost were single-use energy devices (SUD) and endoscopic stapler. We estimate that a saving of over $417 per case is possible by avoiding the use of energy devices and may be as high as $ 984 by adding selective use of staplers. These modifications would result in an annual savings of $1 million for our health system and more than $ 125 million nationwide.


Performing laparoscopic appendectomy with reusable instruments and finding alternatives to expensive energy devices and staplers can significantly decrease costs and does not increase operative time or postoperative complications.

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