Acute Appendicitis
Conditions
Brief summary
In the world, there are several studies comparing the cost-effectiveness between laparoscopic appendectomy and open appendectomy. But in Vietnam, health economics studies for acute appendicitis surgery in general and laparoscopic appendectomy in particular has hardly been available, and in the context of reform of the financial mechanism for payment, questions about the cost-effectiveness between the two surgical methods are particularly concerned. Therefore, we conducted a study Cost-effectiveness analysis and case-based payment norm modeling in patients with appendectomy at Hanoi Medical University Hospital
Detailed description
Acute Appendicitis (AA) is a surgical emergency most common stomach. Appendicitis occurs at all ages. Recently, the rate tends to increase VRTC with age. In the United States, there are about 300,000 cases of appendectomy surgery per year. In Vietnam, according to statistics from a number of other authors showed that the rate of appendectomy surgery accounted for 40.5% - 49.8% of total number of cases of abdominal emergency. Open appendectomy (OA) has long been applied as the gold standard surgical procedure for the treatment of AA for over a century, since it was introduce by McBurrney in 1894 and still be common choice for procedure in many center. In 1981, due to the growth of endoscopic surgery, Semm first introduced the laparoscopic appendectomy, which render a minimal invasive procedure for abdomen and skin, nevertheless, its superiority over open appendectomy (OA) is still being debated. Some more recent paper demonstrate that Laparoscopic Appendectomy is the technique of choice in treatment of AA because of its clinical advantage and cost-effectiveness, however, more than 20 years later, the benefits of LA still remain a controversy for many researchers. There are several studies comparing the cost-effectiveness between laparoscopic appendectomy and open appendectomy in the world. But in Vietnam, health economics studies for appendix removal surgery in general and laparoscopic appendectomy in particular has hardly been available, and in the context of reform of the financial mechanism for payment, questions about the cost-effectiveness between the two surgical methods are particularly concerned. Therefore, we conducted a study Cost-effectiveness analysis and case-based payment norm modeling in patients with appendectomy at Hanoi Medical University Hospital with two main purposes 1. Analyze cost-effectiveness between laparoscopic and open surgery in patients undergoing appendectomy at Hanoi Medical University Hospital in 2011 - 2013 2. Model case-based payment norm of appendectomy patients at Hanoi Medical University Hospital
Interventions
PROCEDURELaparoscopic appendectomy
The laparoscopic appendectomy was performed with three trocars. Pneumoperitoneum was created using an open Hasson technique. The mesoappendix was divided using a harmonic scalpel or endoscopic tissue fusion device. The appendix was divided by placing one endoscopic loop and cut with harmonic scalpel. The specimen was removed through the umbilical port.
PROCEDUREOpen appendectomy
The open appendectomy was carried out in the standard way with McBurney muscle splitting incision.
Sponsors
Hanoi Medical University
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Laparoscopic Appendectomy patients agree to participate in research and are paid by the mode of service charge * Laparoscopic Appendectomy patients agree to participate in research and are paid according to package medical cases
Exclusion criteria
* Patients with combined pathology affecting surgical outcomes * The patient did not agree to participate in research * Patients do not comply with treatment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cost of appendectomy based on health care services fee | 2 years | The expenses that patient pay for acute appendicitis treatment accounted in accordance with services fee of hospital |
| Average cost of hospitalization based on the final hospital bills | 2 years | Total mean expense that patient pay for hospital after completing acute appendicitis treatment |
| Average Cost of medication | 2 years | Total mean cost of drugs used during operation for removal of appendix |
| Overall treatment cost of acute appendicitis patient | From the beginning of hospital admission till discharge from hospital ((an expected average of 10 days, maximum 20 days) | Total amount of money that acute appendicitis patient have to spend during the time of hospitalization |
| Case-based cost of appendectomy | 2 years | The expenses that patient pay for surgical removal of appendix accounted by case-based standardisation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Length of hospital stay | from the beginning of the surgery till discharge from hospital (an expected average of 8 days, maximum 20 days) | No. of days from surgery to discharge of hospital |
| Duration of post-operative pain | from the beginning of the surgery till discharge from hospital (an expected average of 8 days, maximum 20 days) | No. of days that patient experience pain after surgery |
| Degree of post-operative pain | from the beginning of the surgery till discharge from hospital (an expected average of 8 days, maximum 20 days) | Percentage of patients according to stratification of post-operative pain |
| Time until resumption of clear liquid and regular diet | from the beginning of the surgery to the resumption (an expected average 2 days after the surgery | No. of days from surgery to the resumption of clear liquid and regular diet |
| Surgical outcome at hospital discharge | 2 years | Percentage of patients with good outcome at hospital discharge |
Countries
Vietnam
Outcome results
None listed