Transumbilical laparoscopic-assisted appendectomy is associated with lower costs compared to multiport laparoscopic appendectomy ☆ , ☆☆ ,★ Afif N. Kulaylat a, b , Abigail B. Podany a , Christopher S. Hollenbeak b , Mary C. Santos a , Dorothy V. Rocourt a, ⁎ a Division of Pediatric Surgery, Penn State Hershey Medical Center b Department of Public Health Sciences, The Pennsylvania State University, College of Medicine abstract article info Article history: Received 20 January 2014 Received in revised form 5 March 2014 Accepted 20 March 2014 Key words: Appendectomy Costs Single-site Laparoscopic-assisted Background/Purpose: Single-incision laparoscopic appendectomy has been associated with improved cosmetic benefits, and decreased postoperative pain. Less is known about costs and other outcomes. Our aim was to evaluate the costs and outcomes between transumbilical laparoscopic-assisted appendectomy (TULAA) and multiport laparoscopic appendectomy (MLA). Methods: IRB-approved retrospective review (September 2010–July 2013) of institutional medical records identified 372 pediatric patients undergoing laparoscopic appendectomy. Outcomes included costs, LOS and readmission. Costs were fully loaded operating costs from the hospital’s cost accounting database. Generalized linear regression was used to assess costs of MLA and TULAA. A subgroup analysis was performed using only patients with non-perforated appendicitis. Results: There were 132 patients (35.5%) that underwent TULAA while 240 patients (65.5%) underwent MLA. Compared to MLA, TULAA was associated with decreased operative time (0.6 vs. 1.0 h, p b 0.0001), used in comparable proportions of interval appendectomies, but was performed less often for perforated appendicitis (9.8% vs. 22.9%, p = 0.002). Readmission and postoperative complications were similar between both groups. In the setting of non-perforated appendicitis, TULAA was associated with lower costs of $1378 relative to MLA (p = 0.009). Conclusions: In non-perforated appendicitis, TULAA is associated with lower costs and comparable rates of readmission and postoperative complications. © 2014 Elsevier Inc. All rights reserved. Multiport laparoscopic appendectomy (MLA) is one of the most commonly performed pediatric surgical procedures [1]. Recently, attention has been directed towards single-incision laparoscopic approaches for appendectomy, citing potential benefits such as reduced number of incisions, improved cosmetic outcomes, and less postoperative pain due to non-penetration of the muscle [2,3]. While reports on pediatric single-incision laparoscopic appendectomies have demonstrated the safety and efficacy of this procedure, techniques and inclusion criteria have varied between institutions and surgeons [3–10]. The transumbilical laparoscopic-assisted appendectomy (TULAA) is a single-incision technique, which has been suggested to be associated with cost-savings [3,6,7]. Differences in costs have been attributed to the extracorporeal ligation, which is less costly than endomechanical appendectomy. Studies addressing the differences in costs between MLA and TULAA are limited [3,6,7]. Our aim was to characterize the differences in costs between MLA and TULAA, accounting for differences in patient characteristics, operative details and readmissions. We hypothesized that TULAA would be associated with lower costs and comparable outcomes in patients with non- perforated appendicitis. 1. Methods Data were obtained through a query of an institutional electronic medical record (EMR) database for all patients under the age of 17 who underwent an appendectomy between September 2010 and July 2013. Appendectomy was identified using the International Classifi- cation of Diseases, 9th Revision, Clinical Modification (ICD 9-CM), procedural classification (47.0, 47.01, 47.09). This identified 433 patients with appendectomies, operated upon by seven pediatric surgeons at a tertiary Children’s Hospital. Those undergoing open, incidental, or additional procedures during the index operation were excluded (N = 60). There were no patients with laparoscopic converted to open appendectomies. There was one patient who developed appendicitis during a hospitalization for the treatment of a metastatic perianal alveolar rhabdomyosarco- ma. She was also excluded, as her appendectomy course could not be Journal of Pediatric Surgery 49 (2014) 1508–1512 ☆ Funding Source: No internal or external financial support was used for this report. ☆☆ Financial Disclosure: All authors have no financial relationships relevant to this article to disclose. ★ Conflict of Interest: All authors report no potential conflicts of interest. ⁎ Corresponding author at: Division of Pediatric Surgery, Department of Surgery, Penn State Hershey Children’s Hospital, 500 University Drive, Hershey, PA 17033-0850. Tel.: +1 717 531 8342; fax: +1 717 531 4185. E-mail address: drocourt@hmc.psu.edu (D.V. Rocourt). http://dx.doi.org/10.1016/j.jpedsurg.2014.03.016 0022-3468/© 2014 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg