Abstract
Introduction
Laparoscopic appendectomy (LA) is the first-line treatment for acute appendicitis. We compared Hem-O-Lok clips (HOL) and endoscopic staplers to evaluate cost savings without compromising outcomes within the San Bernadino service area Kaiser Permanente Health Maintenance Organization.
Methods
This retrospective case-control study included patients ≥6 years who underwent LA (2016-2022) using HOL clips or ES for stump closure. Of 571 patients, 341 used HOL and 230 ES based on surgeon preference. Propensity score matching (1:1) by age, sex, Body Mass Index (BMI), and American Society of Anesthesiologist (ASA) Physical Status Classification yielded 177 pairs. Outcomes included 30-day complications, length of stay, estimated blood loss (EBL), and readmission.
Results
Patients in the HOL group were significantly older, had more comorbidities, had higher BMI values, and classified as ASA II or higher. The diagnosis of acute appendicitis was more frequent in the HOL group (81.3% vs 73.0%) and gangrenous disease more common in ES group (6.1% vs 1.5%). Despite this, there was no increased post-operative complication rates between the two groups. Return to the hospital were similar between the two groups (5.3% vs 7.9%). The cost per ES load is $273 compared to a six pack of HOL clips costing $32.
Conclusion
HOL clips in LA showed no increase in morbidity, supporting a lower-cost alternative.
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