Incidental appendectomy: 18-year pathologic survey and cost effectiveness in the nonmanaged-care setting.

Background: Incidental appendectomy (IA) remains a controversial issue. The role of IA in the nonmanaged-care setting has not been evaluated recently. This study evaluates the cost-benefit of IA based on current third-party reimbursements and reports the incidence of pathology from routine IA during an 18-year period.

Study Design: A retrospective review was performed for all patients who underwent open intestinal operations for nonappendiceal pathology by a single colon and rectal surgeon between 1988 and 2006. Patient records were reviewed for surgical indication, procedure, pathology reports, and complications. A cost-benefit analysis for IA versus laparoscopic appendectomy was performed using previously published epidemiologic data for risk of appendectomy.

Results: During this period, 341 patients (mean age 62.9 years) underwent IA during open intestinal operation. Malignancy was the indication for operation in 61.6%. Pathologic findings of clinical significance in the appendix were present in 2.6% of specimens. Combined reimbursements for laparoscopic appendectomy for nonruptured and ruptured appendicitis are 8,500.95 dollars and 15,870.37 dollars, respectively. For patients with a benign surgical indication, there was cost-benefit for IA during open operation for men younger than 55 years and women younger than 50 years of age. For patients with malignant disease, there was cost-benefit for men and women younger than 45 years of age.

Conclusions: IA can be performed safely during open operation for other bowel pathology. Rate of clinically significant appendiceal pathology is low but not negligible. For patients with third-party payor status, IA can be more broadly performed during open gastrointestinal operation when no additional surgeon reimbursement is obtained.