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J Pediatr Surg ; 46(12): 2336-41, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22152877

RESUMO

BACKGROUND: A technique for laparoscopic appendectomy (LAP APPY) that involves brief surgeon and operating room times, results in no appreciable scar, and requires few disposable supplies would be desirable. METHODS: During 2009, 508 children underwent LAP APPY at our institution including 398 (78%) for acute, non-perforated appendicitis. Our "all-in-one" operative procedure involves use of a single instrument through a side-arm viewing operative laparoscope which is inserted through a single, trans-umbilical port. Successful procedure completion rates and operative times ("cut-to-close") were determined. Our data for surgeon-directed, disposable supply costs per procedure were collated by Child Health Corporation of America and compared with 2009 LAP APPY data (n = 5692) from 17 other children's hospitals in the United States. RESULTS: We successfully completed 359 (90.2%) LAP APPY procedures using the all-in-one technique resulting in no appreciable scar. Additional ports were used in 9.8% and there were no conversions to open procedures. Median operative time for the all-in-one technique was 24 minutes (5-66 min). Our median surgeon-directed, disposable supply cost was the lowest in the study group and significantly less than the other 17 children's hospitals ($166 vs $748, P < .001). Median variation of supply costs among surgeons within each institution was $448 ($3-$870). Aggregate savings of nearly $1.3 million are predicted if all study surgeons were to reduce their disposable costs per procedure to the 25th percentile ($551). CONCLUSIONS: We conclude that the all-in-one laparoscopic appendectomy technique is quick, scarless, and less costly than conventional multi-port techniques. Wider application of the all-in-one technique seems indicated.


Assuntos
Apendicectomia/métodos , Laparoscopia/métodos , Antibacterianos/economia , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/economia , Apendicectomia/economia , Apendicectomia/instrumentação , Apendicectomia/estatística & dados numéricos , Apendicite/cirurgia , Criança , Cicatriz/prevenção & controle , Redução de Custos , Equipamentos Descartáveis/economia , Custos de Medicamentos/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Hospitais Pediátricos/economia , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Laparoscopia/economia , Laparoscopia/estatística & dados numéricos , Tempo de Internação/economia , Instrumentos Cirúrgicos/economia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/economia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Fatores de Tempo , Umbigo , Estados Unidos/epidemiologia
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