A systematic review on the cost evaluation of two different laparoscopic surgical techniques among 996 appendectomies fr
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ORIGINAL ARTICLE
A systematic review on the cost evaluation of two different laparoscopic surgical techniques among 996 appendectomies from a single center Noemi Zorzetti1 · Augusto Lauro2 · Samuele Vaccari3 · Alessandro Ussia2 · Manuela Brighi2 · Vito D’andrea3 · Maurizio Cervellera2 · Valeria Tonini2 Received: 21 October 2019 / Accepted: 20 May 2020 © Italian Society of Surgery (SIC) 2020
Abstract Acute appendicitis is one of the main indications for urgent surgery representing a high-volume procedure worldwide. The current spending review in Italy (and not only in this country) affects the health service and warrants care regarding the use of different surgical devices. The aim of our study is to perform a cost evaluation, comparing the use of endoloops and staplers in complicated acute appendicitis (phlegmonous and gangrenous), taking into consideration the cost of the device in relation to the management of any associated postoperative complications. We retrospectively evaluated 996 laparoscopic appendectomies of adult patients performed in the Emergency General Surgery—St. Orsola University Hospital in Bologna (Italy). Surgical procedures together with the related choice of using endoloops or staplers were performed by attending surgeons or resident surgeons supervised by a tutor. A systematic review was performed to compare our outcomes with those reported in the literature. In our experience, the routine use of endoloop leads to a real estimated saving of 375€ for each performed laparoscopic appendectomy, even considering post-operative complications. Comparing endoloop and stapler groups, the total number of complications is significantly lower in the endoloop group. Our systematic review confirmed these findings even if the superiority of one technique has not been proved yet. Our analysis shows that the routine use of endoloop is safe in most patients affected by acute appendicitis, even when complicated, and it is a cost-effective device even when taking into consideration extra costs for potential post-operative complications. Keywords Acute appendicitis · Laparoscopic appendectomy · Endoloop · Stapler · Cost analysis · Post-operative complications
Introduction Acute appendicitis (AA) is one of the most frequent causes of acute abdominal pain and the lifetime chance of developing AA is around 6.7% in females and 8.6% in males, while the risk of undergoing surgery is 23% and 12%, respectively [1]. Based on these data, AA is one of the main indications * Noemi Zorzetti [email protected] 1
Department of General Surgery, “Santa Maria Delle Croci” Hospital, Ravenna, Italy
2
Emergency General Surgery, St. Orsola University Hospital, Bologna, Italy
3
Department of Surgical Sciences, La Sapienza University Hospital, Rome, Italy
for urgent surgery and can be considered a high-volume procedure worldwide. In adult patients, laparoscopic appendectomy (LA) has shown advantages in terms of clinical results and cost-effectiveness [2–12] even if there are still few controversies [9, 13–23]
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