Surgery MINIMALLY INVASIVE APPENDETOMY AS A COST-EFFICIENT STANDARD OF CARE: RANDOMIZED TRAIL OF LAPAROSCOPIC VS . OPEN

Background: Acute appendicitis necessitates prompt surgical intervention, traditionally via open appendectomy (OA). Laparoscopic appendectomy (LA) offers theoretical advantages but faces economic constraints in resource-limited settings. This study evaluates the comparative cost-effectiveness and clinical outcomes of LA versus OA in a tertiary Indian hospital. A prospective randomized trial (April 2023–March 2025) allocated 100 patients with Methods: acute appendicitis to OA (n = 50) or LA (n = 50). Primary endpoints included operative metrics, hospitalization duration, complications (surgical site infections [SSI], intra-abdominal abscess [IAA]), direct/indirect costs, and time to functional recovery. Statistical analysis employed t-tests, chi-square tests, and incremental cost-effectiveness ratios (ICERs).Results: LA demonstrated a modestly prolonged operative duration (32.4 ± 4.1 min vs. 22.6 ± 3.8 min; p = 0.001) but significantly reduced hospital stays (2.8 ± 0.6 days vs. 5.0 ± 1.1 days; p < 0.001) and aggregate complications (10% vs. 27%; RR 0.37, 95% CI 0.21–0.65). SSI incidence was 67% lower with LA (4% vs. 12%; p = 0.008). Direct procedural costs were higher for LA (9,071 vs. 6,548), yet total societal costs favored LA (12,671 vs. 13,148) due to reduced pharmacotherapy expenses (1,600 vs. 2,600) and productivity loss (1,800 vs. 3,800). ICER was 78,500 per quality-adjusted life year (QALY), below India's cost-effectiveness threshold (150,000). Despite hi Conclusion: gher initial costs, LA is clinically and socioeconomically superior to OA, offering reduced morbidity, accelerated recovery, and long-term cost efficiency. It is recommended as the preferred approach for uncomplicated acute appendicitis in resource-constrained