Comparison of outcomes and cost-effectiveness of laparoscopic and open appendectomies in public health services
ABSTRACT Acute appendicitis is the leading cause of abdominal emergency surgery worldwide and appendectomy continues to be the definitive treatment of choice. This cost-effectiveness analysis evaluates laparoscopic versus open appendectomies performed in public health services in the state of Bahia...
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| Veröffentlicht in: | Revista do Colégio Brasileiro de Cirurgiões 2021, Vol.48 |
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| creator | NASCIMENTO, JOÃO HENRIQUE FONSECA DO SOUZA FILHO, BENJAMIM MESSIAS DE TOMAZ, SELTON CAVALCANTE VIEIRA, ADRIANO TITO SOUZA CANEDO, BERNARDO FERNANDES ANDRADE, ANDRÉ BOUZAS DE GUSMÃO-CUNHA, ANDRÉ |
| description | ABSTRACT Acute appendicitis is the leading cause of abdominal emergency surgery worldwide and appendectomy continues to be the definitive treatment of choice. This cost-effectiveness analysis evaluates laparoscopic versus open appendectomies performed in public health services in the state of Bahia (Brazil). We conducted a retrospective observational study using the database from the Department of Informatics of the Unified Health System (DATASUS). Available data on appendectomies between 2008 and 2019 were included, and we evaluated the temporal trend of hospital admissions, procedure-related mortality rates, length of stay, and costs. Statistical analysis was performed using the R-software (R Foundation, v.4.0.3) and the BioEstat software (IMDS, v. 5.3), considering p |
| doi_str_mv | 10.1590/0100-6991e-20213010 |
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RESUMO Apendicite aguda é a principal causa de cirurgia abdominal de emergência no mundo e a apendicectomia continua sendo o tratamento definitivo de escolha. A presente investigação avalia desfechos e custos das apendicectomias laparoscópicas versus abertas realizadas em serviços públicos de saúde no estado da Bahia (Brasil). Realizou-se estudo observacional retrospectivo, utilizando a base de dados do DATASUS. Incluiu-se dados disponíveis sobre apendicectomias na Bahia entre 2008 e 2019, avaliando-se a tendência temporal de internações, taxas de mortalidade por procedimentos, tempo de permanência e custos. A análise estatística foi realizada no R-software (Fundação R, v.4.0.3) e no software BioEstat (IMDS, v.5.3), considerando p<0,05 significativo. Entre 2008 e 2019, realizou-se 53.024 apendicectomias no serviço público de saúde na Bahia, das quais 94,9% foram cirurgias abertas. A laparotomia foi associada à maior taxa de mortalidade (4,9/1.000 procedimentos; p<0,05) e maior risco de morte (RR=4,5; p<0,05) do que laparoscopia (1,1/1.000 procedimentos). Apendicectomia laparoscópica (mediana de 2,7 dias) obteve menor tempo de internamento do que cirurgia laparotômica (mediana de 4,15 dias) (p<0,05). Não houve diferença entre as medianas dos custos e nem dos serviços hospitalares por procedimento (p=0,08 e p=0,08, respectivamente). A mediana do custo de profissionais na laparoscopia foi significativamente mais elevada, em US$ 1,39 (p<0,05). A cirurgia minimamente invasiva para apendicite é um procedimento seguro e eficaz, proporcionando vantagens sobre a laparotomia (incluindo menor taxa de mortalidade e alta precoce), não implicando, por sua vez, em maiores despesas para cofres públicos no estado da Bahia.]]></description><identifier>ISSN: 0100-6991</identifier><identifier>EISSN: 1809-4546</identifier><identifier>DOI: 10.1590/0100-6991e-20213010</identifier><identifier>PMID: 34644742</identifier><language>eng</language><publisher>Colégio Brasileiro de Cirurgiões</publisher><subject>Appendectomy ; Cost-Benefit Analysis ; Laparoscopy ; Original ; Public Health</subject><ispartof>Revista do Colégio Brasileiro de Cirurgiões, 2021, Vol.48</ispartof><rights>2021 Revista do Colégio Brasileiro de Cirurgiões 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4030-5cbb4ff3279050dfd3a320513739a7a63841b739e5980ab0739bb07da86b6203</citedby><cites>FETCH-LOGICAL-c4030-5cbb4ff3279050dfd3a320513739a7a63841b739e5980ab0739bb07da86b6203</cites><orcidid>0000-0001-7762-168X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10683419/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10683419/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,4024,27923,27924,27925,53791,53793</link.rule.ids></links><search><creatorcontrib>NASCIMENTO, JOÃO HENRIQUE FONSECA DO</creatorcontrib><creatorcontrib>SOUZA FILHO, BENJAMIM MESSIAS DE</creatorcontrib><creatorcontrib>TOMAZ, SELTON CAVALCANTE</creatorcontrib><creatorcontrib>VIEIRA, ADRIANO TITO SOUZA</creatorcontrib><creatorcontrib>CANEDO, BERNARDO FERNANDES</creatorcontrib><creatorcontrib>ANDRADE, ANDRÉ BOUZAS DE</creatorcontrib><creatorcontrib>GUSMÃO-CUNHA, ANDRÉ</creatorcontrib><title>Comparison of outcomes and cost-effectiveness of laparoscopic and open appendectomies in public health services</title><title>Revista do Colégio Brasileiro de Cirurgiões</title><description><![CDATA[ABSTRACT Acute appendicitis is the leading cause of abdominal emergency surgery worldwide and appendectomy continues to be the definitive treatment of choice. This cost-effectiveness analysis evaluates laparoscopic versus open appendectomies performed in public health services in the state of Bahia (Brazil). We conducted a retrospective observational study using the database from the Department of Informatics of the Unified Health System (DATASUS). Available data on appendectomies between 2008 and 2019 were included, and we evaluated the temporal trend of hospital admissions, procedure-related mortality rates, length of stay, and costs. Statistical analysis was performed using the R-software (R Foundation, v.4.0.3) and the BioEstat software (IMDS, v. 5.3), considering p<0.05 as significant. During 2008-2019, 53,024 appendectomies were performed in the public health services in Bahia, of which 94.9% were open surgeries. The open technique was associated with a higher mortality rate (4.9/1,000 procedures; p<0.05) and a higher risk of death (RR=4.5; p<0.05) compared to laparoscopy (1.1/1,000 procedures). Laparoscopic appendectomy (median of 2.7 days) had a shorter length of stay compared to laparotomy (median of 4.15 days) (p<0.05). There was no difference in the medians of costs nor hospital services, per procedure (p=0.08 and p=0.08, respectively). Laparoscopic professional median costs were higher by US$ 1.39 (p<0.05). Minimally invasive surgery for appendicitis is a safe and efficacious procedure in Brazilian public health care services, as it provides advantages over the open method (including lower procedure-related mortality rate and earlier discharges), and it did not imply higher expenses for public service budgets in the state of Bahia.
RESUMO Apendicite aguda é a principal causa de cirurgia abdominal de emergência no mundo e a apendicectomia continua sendo o tratamento definitivo de escolha. A presente investigação avalia desfechos e custos das apendicectomias laparoscópicas versus abertas realizadas em serviços públicos de saúde no estado da Bahia (Brasil). Realizou-se estudo observacional retrospectivo, utilizando a base de dados do DATASUS. Incluiu-se dados disponíveis sobre apendicectomias na Bahia entre 2008 e 2019, avaliando-se a tendência temporal de internações, taxas de mortalidade por procedimentos, tempo de permanência e custos. A análise estatística foi realizada no R-software (Fundação R, v.4.0.3) e no software BioEstat (IMDS, v.5.3), considerando p<0,05 significativo. Entre 2008 e 2019, realizou-se 53.024 apendicectomias no serviço público de saúde na Bahia, das quais 94,9% foram cirurgias abertas. A laparotomia foi associada à maior taxa de mortalidade (4,9/1.000 procedimentos; p<0,05) e maior risco de morte (RR=4,5; p<0,05) do que laparoscopia (1,1/1.000 procedimentos). Apendicectomia laparoscópica (mediana de 2,7 dias) obteve menor tempo de internamento do que cirurgia laparotômica (mediana de 4,15 dias) (p<0,05). Não houve diferença entre as medianas dos custos e nem dos serviços hospitalares por procedimento (p=0,08 e p=0,08, respectivamente). A mediana do custo de profissionais na laparoscopia foi significativamente mais elevada, em US$ 1,39 (p<0,05). A cirurgia minimamente invasiva para apendicite é um procedimento seguro e eficaz, proporcionando vantagens sobre a laparotomia (incluindo menor taxa de mortalidade e alta precoce), não implicando, por sua vez, em maiores despesas para cofres públicos no estado da Bahia.]]></description><subject>Appendectomy</subject><subject>Cost-Benefit Analysis</subject><subject>Laparoscopy</subject><subject>Original</subject><subject>Public Health</subject><issn>0100-6991</issn><issn>1809-4546</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNpVkdtOwzAMhiMEYmPwBNz0BQpOkx5yhdDESULiZveRk7pbprapmm4Sb0-2wSRuHMf5_Ef2z9g9hweeK3gEDpAWSnFKM8i4iPcLNucVqFTmsrhk8zMxYzchbAGk4Epcs5mQhZSlzObML3034OiC7xPfJH43Wd9RSLCvE-vDlFLTkJ3cnnoK4YC0GHkfrB-cPWJ-oD7BIcY6kr5zsd31ybAzbSQ2hO20SQKNe2cp3LKrBttAd7_ngq1eX1bL9_Tz6-1j-fyZWgkC0twaI5tGZKWCHOqmFigyyLkohcISC1FJbmJOuaoADcTUxFhjVZgiA7FgHyfZ2uNWD6PrcPzWHp0-Fvy41jhOzrakZVlmnNv4BRmpbGXqAo1VGUnipeUUtZ5OWnGijmpL_TRi-0_0_0vvNnrt95pDUQkZN75g4qRg4-LCSM25mYM-eKkPTumjl_rPS_EDnSiTBA</recordid><startdate>2021</startdate><enddate>2021</enddate><creator>NASCIMENTO, JOÃO HENRIQUE FONSECA DO</creator><creator>SOUZA FILHO, BENJAMIM MESSIAS DE</creator><creator>TOMAZ, SELTON CAVALCANTE</creator><creator>VIEIRA, ADRIANO TITO SOUZA</creator><creator>CANEDO, BERNARDO FERNANDES</creator><creator>ANDRADE, ANDRÉ BOUZAS DE</creator><creator>GUSMÃO-CUNHA, ANDRÉ</creator><general>Colégio Brasileiro de Cirurgiões</general><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-7762-168X</orcidid></search><sort><creationdate>2021</creationdate><title>Comparison of outcomes and cost-effectiveness of laparoscopic and open appendectomies in public health services</title><author>NASCIMENTO, JOÃO HENRIQUE FONSECA DO ; SOUZA FILHO, BENJAMIM MESSIAS DE ; TOMAZ, SELTON CAVALCANTE ; VIEIRA, ADRIANO TITO SOUZA ; CANEDO, BERNARDO FERNANDES ; ANDRADE, ANDRÉ BOUZAS DE ; GUSMÃO-CUNHA, ANDRÉ</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4030-5cbb4ff3279050dfd3a320513739a7a63841b739e5980ab0739bb07da86b6203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Appendectomy</topic><topic>Cost-Benefit Analysis</topic><topic>Laparoscopy</topic><topic>Original</topic><topic>Public Health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>NASCIMENTO, JOÃO HENRIQUE FONSECA DO</creatorcontrib><creatorcontrib>SOUZA FILHO, BENJAMIM MESSIAS DE</creatorcontrib><creatorcontrib>TOMAZ, SELTON CAVALCANTE</creatorcontrib><creatorcontrib>VIEIRA, ADRIANO TITO SOUZA</creatorcontrib><creatorcontrib>CANEDO, BERNARDO FERNANDES</creatorcontrib><creatorcontrib>ANDRADE, ANDRÉ BOUZAS DE</creatorcontrib><creatorcontrib>GUSMÃO-CUNHA, ANDRÉ</creatorcontrib><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>Revista do Colégio Brasileiro de Cirurgiões</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>NASCIMENTO, JOÃO HENRIQUE FONSECA DO</au><au>SOUZA FILHO, BENJAMIM MESSIAS DE</au><au>TOMAZ, SELTON CAVALCANTE</au><au>VIEIRA, ADRIANO TITO SOUZA</au><au>CANEDO, BERNARDO FERNANDES</au><au>ANDRADE, ANDRÉ BOUZAS DE</au><au>GUSMÃO-CUNHA, ANDRÉ</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of outcomes and cost-effectiveness of laparoscopic and open appendectomies in public health services</atitle><jtitle>Revista do Colégio Brasileiro de Cirurgiões</jtitle><date>2021</date><risdate>2021</risdate><volume>48</volume><issn>0100-6991</issn><eissn>1809-4546</eissn><abstract><![CDATA[ABSTRACT Acute appendicitis is the leading cause of abdominal emergency surgery worldwide and appendectomy continues to be the definitive treatment of choice. This cost-effectiveness analysis evaluates laparoscopic versus open appendectomies performed in public health services in the state of Bahia (Brazil). We conducted a retrospective observational study using the database from the Department of Informatics of the Unified Health System (DATASUS). Available data on appendectomies between 2008 and 2019 were included, and we evaluated the temporal trend of hospital admissions, procedure-related mortality rates, length of stay, and costs. Statistical analysis was performed using the R-software (R Foundation, v.4.0.3) and the BioEstat software (IMDS, v. 5.3), considering p<0.05 as significant. During 2008-2019, 53,024 appendectomies were performed in the public health services in Bahia, of which 94.9% were open surgeries. The open technique was associated with a higher mortality rate (4.9/1,000 procedures; p<0.05) and a higher risk of death (RR=4.5; p<0.05) compared to laparoscopy (1.1/1,000 procedures). Laparoscopic appendectomy (median of 2.7 days) had a shorter length of stay compared to laparotomy (median of 4.15 days) (p<0.05). There was no difference in the medians of costs nor hospital services, per procedure (p=0.08 and p=0.08, respectively). Laparoscopic professional median costs were higher by US$ 1.39 (p<0.05). Minimally invasive surgery for appendicitis is a safe and efficacious procedure in Brazilian public health care services, as it provides advantages over the open method (including lower procedure-related mortality rate and earlier discharges), and it did not imply higher expenses for public service budgets in the state of Bahia.
RESUMO Apendicite aguda é a principal causa de cirurgia abdominal de emergência no mundo e a apendicectomia continua sendo o tratamento definitivo de escolha. A presente investigação avalia desfechos e custos das apendicectomias laparoscópicas versus abertas realizadas em serviços públicos de saúde no estado da Bahia (Brasil). Realizou-se estudo observacional retrospectivo, utilizando a base de dados do DATASUS. Incluiu-se dados disponíveis sobre apendicectomias na Bahia entre 2008 e 2019, avaliando-se a tendência temporal de internações, taxas de mortalidade por procedimentos, tempo de permanência e custos. A análise estatística foi realizada no R-software (Fundação R, v.4.0.3) e no software BioEstat (IMDS, v.5.3), considerando p<0,05 significativo. Entre 2008 e 2019, realizou-se 53.024 apendicectomias no serviço público de saúde na Bahia, das quais 94,9% foram cirurgias abertas. A laparotomia foi associada à maior taxa de mortalidade (4,9/1.000 procedimentos; p<0,05) e maior risco de morte (RR=4,5; p<0,05) do que laparoscopia (1,1/1.000 procedimentos). Apendicectomia laparoscópica (mediana de 2,7 dias) obteve menor tempo de internamento do que cirurgia laparotômica (mediana de 4,15 dias) (p<0,05). Não houve diferença entre as medianas dos custos e nem dos serviços hospitalares por procedimento (p=0,08 e p=0,08, respectivamente). A mediana do custo de profissionais na laparoscopia foi significativamente mais elevada, em US$ 1,39 (p<0,05). A cirurgia minimamente invasiva para apendicite é um procedimento seguro e eficaz, proporcionando vantagens sobre a laparotomia (incluindo menor taxa de mortalidade e alta precoce), não implicando, por sua vez, em maiores despesas para cofres públicos no estado da Bahia.]]></abstract><pub>Colégio Brasileiro de Cirurgiões</pub><pmid>34644742</pmid><doi>10.1590/0100-6991e-20213010</doi><orcidid>https://orcid.org/0000-0001-7762-168X</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Appendectomy Cost-Benefit Analysis Laparoscopy Original Public Health |
| title | Comparison of outcomes and cost-effectiveness of laparoscopic and open appendectomies in public health services |
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