Is emergency laparoscopic appendicectomy a financially viable procedure for the public healthcare system?

Abstract

Acute appendicitis is one of the most common emergency surgical presentations in the world, and laparoscopic surgical access has become frequent in Brazilian hospitals, posing great challenges to public managers. This is a retrospective study of the period from January 2018 to December 2021. The study included patients older than 14 years, with confirmed diagnosis of acute appendicitis and submitted to surgical treatment, in the period from July 2019 to December 2021. For the economic evaluation, operative time, costs of materials and medication, hospitalization, medical assistance and emergency care were analyzed. A total of 136 patients undergoing open surgery and 227 patients undergoing laparoscopic surgery were included. The average age was 32 years and 56% were male. In the cost analysis, the laparoscopic appendectomy presented statistically higher values in the cost of medicines and materials, p<0.001 (median of R$595 vs. R$371); medical fees, p<0.001 (median of R$1,414 vs. R$1,012); surgical room, p<0.001 (median of R$1,240 vs. R$741); and total cost, p<0.001 (median R$5,014 vs. R$3,714). Open access proves to be the most suitable procedure from the hospital perspective,
since laparoscopic access is the most beneficial from the perspective of the patient and society.