||Objectives: The aim of this study is to compare the difference of hospitalized costs between open appendectomy (OA) and laparoscopic appendectomy (LA). We will evaluated the influence of hospitalized costs among the patients who had received appendectomy after Tw-DRGs was apply. We were also exploring the impact of medical payment system on declaration of expense differences in our study at the same time.|
Methods: This is a cross-sectional study design. The patient’s data was retrospectives collection by chart review from a general teaching hospital in the Kaohsiung city. Between January 1, 2008 and December 31, 2011, 1100 patients were received with appendectomy. We defined the year of case payment from 2008 to 2009, and the Tw-DRGs from 2010 to 2011. After exclude 53 patients who had uncompleted data or repeated cases. Of these, 1047 patients met the inclusion criteria and we analyzed the patient’s clinical data, hospitalized costs, and hospital declaration of expense differences.
Results: All of the 1047 patients, there were 555 male (53.0%) and 492 female (47.0) and with a mean age of 41.4 (17.3) years. Of these, 431 patients had LA and the remaining 616 had OA. The mean length of stay was relatively shorter for LA (3.37+/-1.60 days) compare to OA (5.18+/-3.88 days; p<0.001). But the complication within 14 days (LA 0.9% vs. OA 1.3%) and death within 30 days (no case occur in LA or OA) after surgery was no significant differences between LA and OA. The mean of hospitalized costs was significant lower for LA (35347.3+/-8544.7 dollars) compare to OA (39042.4+/-19716.3 dollars; p<0.001). The total patient’s mean hospital declaration of expense differences was 886.5+/15769.6 dollars, but divided into 2 types of appendectomy were different (LA 3674.1+/- 7503.6 dollars vs. OA -1064.0+/-19772.6 dollars; p<0.001). When we used the multiple regression models that were control other factors which were associated with hospitalized costs, hospital declaration of expense differences, and case profit. The mean hospitalized costs on LA 3574.2 dollars were more expensive than OA (increase 12.1%). The effect size of LA compare to OA was lower degree level (0.23 to 0.24). We founded that years of Tw-DRGs compare to case payment was not significant decreased the patient’s hospitalized costs. But in each type of appendectomy groups, the patient’s hospitalized costs were both decreased (LA was -2987.1 dollars, decreased 7.6% and OA was -2493.3 dollars, decreased 4.5%) after Tw-DRGs system was apply in Taiwan. Based on year of 2008, the hospital declaration of expense differences were decreased 177.2 dollars in year of 2009, and both increased 9082.8 dollars and 10880.9 dollars in year of 2010 and 2011. In the multiple linear regression model, the hospital declaration of expense differences was decreased 1142.4 dollars when LA compare to OA, but no statistically significant (p=0.184). In the multiple logistical regression model, compare the OR of case profit between LA and OA was decrease (crude OR was 0.505 and adjusted OR was 0.019).
Conclusion: In our study shows that the Tw-DRGs system compared with case payment system will be increases the hospital profit when treatment patients who received appendectomy. But we suggested that choice LA compare to OA will increase patient’s hospitalized cost. Surgeons selective LA or OA to treatment acute appendicitis will no significant influences on hospital declaration of expense differences.