Laparoscopic appendectomy improves outcomes and reduces costs in rural Kenya
- 06.02.2025
Erschienen in:
- Verfasst von
- Kemunto Otoki
- Ian Simel
- Daniel Moenga
- Patricia Chesang
- Robert K. Parker
- Erschienen in
- Surgical Endoscopy | Ausgabe 4/2025
Abstract
Background
Acute appendicitis is a common emergency in rural Kenya. While open appendectomy is widely used, minimally invasive approaches may improve postoperative recovery and superficial surgical site infection rates. However, adoption in resource-limited settings is hindered by cost and availability, with fewer than 1% of operations involving laparoscopy. This study evaluates the effectiveness and costs of laparoscopic versus open appendectomy to inform practices in similar settings.
Methods
A retrospective study at Tenwek Hospital, Kenya (2015–2019), compared laparoscopic and open appendectomy using a bottom-up micro-costing method for true healthcare costs, adjusted for inflation and expressed in international dollars using purchasing power parity (I$PPP). Outcomes, including operating room turnaround time, hospital length of stay, superficial surgical site infections, and financial impact, were analyzed with Pearson’s chi-squared, Wilcoxon rank-sum tests, and a multilevel generalized linear model to adjust for patient comorbidities and severity.
Results
Among 168 patients, median age was 34 years (IQR: 26–44), with 71% men, and perforation in 45%. Laparoscopic surgery was performed on 31 patients, with one conversion, versus open surgery in 137. The laparoscopic group had longer operating room turnaround times (115 vs. 75 min, p < 0.001) but shorter hospital stays (2 vs. 4 days, p = 0.002). Total costs were lower for laparoscopy cases (1527 vs. 1816 I$PPP, p = 0.049), with surgical site infections (3.2% vs. 16.7%, p = 0.026).
Conclusions
Despite longer surgery times, laparoscopic appendectomy significantly reduces hospital stays, total costs, and surgical site infections compared to open surgery in rural Kenya.
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- Titel
- Laparoscopic appendectomy improves outcomes and reduces costs in rural Kenya
- Verfasst von
-
Kemunto Otoki
Ian Simel
Daniel Moenga
Patricia Chesang
Robert K. Parker
- Publikationsdatum
- 06.02.2025
- Verlag
- Springer US
- Erschienen in
-
Surgical Endoscopy / Ausgabe 4/2025
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218 - DOI
- https://doi.org/10.1007/s00464-025-11589-5
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