Cost analysis of ligature versus stapling techniques of laparoscopic appendectomy in children

Background: Although longer operative times and specialized instrumentation render laparoscopic appendectomies (LA) more expensive to perform than open appendectomies, the documented advantages of the laparoscopic approach have led many surgeons to prefer it. LAs are currently performed using either the ligature or the stapling technique. The decision as to which technique to employ is currently based on the surgeon's personal preference rather than on a knowledge of comparative costs. In light of the pressures for cost containment, we evaluated data from both laparoscopic methods to determine which was more effective based on cost and patient outcomes. Patients and Methods: We conducted a retrospective review of 55 pediatric patients who underwent LA by either the ligature or stapling technique at Cincinnati Children's Hospital Medical Center (Cincinnati, OH) between March 2000 and March 2001. Comparative data on operating room cost, operative time, length of hospital stay, and readmission owing to complications were obtained for all LA cases. Results: The cost of LA performed using the stapling technique was significantly higher than the cost of LA using the ligature technique. Overall, a 37% reduction in operating room cost was seen for ligature versus stapling LA. There were no statistically significant differences in any of the other variables measured. Conclusions: The ligation technique has appeal in residency training situations owing to the greater skill set that is needed for tissue handling and manipulation when using this technique. Our data suggest that LA performed using a ligation technique may also be less costly than the stapling technique and, therefore, should be considered as an appropriate surgical option.