A. E. Wagenaar1, J. Tashiro1, J. C. Langer2, E. A. Perez1, J. E. Sola1 1University Of Miami,Surgery,Miami, FL, USA 2University of Toronto,Surgery,Toronto, Ontario, Canada
Introduction: We hypothesized that clinical outcomes differ between laparoscopic appendectomy (LA) and laparoscopic converted to open appendectomy (CA).
Methods: We queried the Kids’ Inpatient Database (1997-2012) for simple (540.9) and complicated (540.0, 540.1) appendicitis treated with LA or CA. Propensity score (PS)-matched analysis compared outcomes associated with LA and CA, using 41 pre-procedure variables (demographic and socioeconomic variables, hospital characteristics, facility preference for laparoscopy).
Results: Overall, 327,748 cases of simple appendicitis were treated with LA (98.9%) and CA (1.1%), whereas 64,394 cases of complicated appendicitis had LA (92.4%) and CA (7.6%).
On 1:1 propensity score (PS)-matched analyses of simple appendicitis (1976 LA: 2073 CA), CA had higher rates of wound infection (odds ratio: 4.2), pneumonia (4.0), transfusion requirement (3.7), sepsis (3.5), and other infections (2.0), p<0.04. Length of stay (LOS), total charges (TC), and cost were higher in CA vs. LA, p<0.001.
For complicated appendicitis (2747 LA: 2777 CA), CA had higher rates of incision and drainage of wound (17.9), intraoperative perforation (17.9), surgical misadventure (8.9), transfusion requirement (2.8), pneumonia (2.0), wound infection (1.9), sepsis (1.8), p<0.002. CA patients were more likely to require home healthcare upon discharge (2.9), p<0.001. LOS, TC, and cost were higher in CA vs. LA, p<0.001.
Conclusion: Conversion from laparoscopic to open is more common for complicated appendicitis and an indicator of significantly higher morbidity and resource utilization for both simple and complicated appendicitis. In a PS-matched comparison (including facility procedure preference) higher complication rates, LOS, TC, and cost were associated with cases converted to open.