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.

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.

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 and $15,870.37, 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.

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.