M. I. Orloff1, J. Lu1, N. Matolo1, S. Kolakowski1, D. Vyas1, A. Dayama1 1San Joaquin General Hospital,Surgery,French Camp, CA, USA
Introduction: Laparoscopic appendectomy is the standard of care for non-perforated appendicitis, however its role in complicated appendicitis remains unclear. In this study we compared perioperative outcomes of open appendectomy (OA), laparoscopic appendectomy (LA), and laparoscopic converted to open appendectomy (LCOA) in the U.S. Adult population.
Methods: We reviewed the ACS-NSQIP targeted appendectomy data sets from 2016 to identify patients with complicated appendicitis, who underwent an appendectomy. Complicated appendicitis was defined as perforated appendicitis with and without abscess. The primary outcomes of our study were intraabdominal abscess, surgical site infection, length of stay, reoperation and 30-day mortality. Multivariate logistic regression was performed to determine the association of surgical approach and intraabdominal abscess formation.
Results: A total of 2826 patients met our inclusion criteria – 2505 underwent LA, 185 underwent LCOA and 149 underwent OA. The rate of surgical site infection was lower in the LA cohort (1.2%) compared to the LCOA (9.4%) and OA (8.8%) cohorts, p < 0.01. The rate of postoperative intraabdominal abscess was 9.1% in the LA, 10.5% in LCOA and 18.2% in OA cohort, p < 0.01. Length of stay was lowest in patients who underwent LA 3.2 days (d), compared to 5.8 d in LCOA and 6.7 d OA cohorts, p < 0.01. The rate of reoperation was 2.2% in the LA cohort compared to 5.5% in the LCOA and 6.8% in OA cohorts, p < 0.01. No difference was seen in mortality between the three cohorts. The multivariate analysis revealed a statistically significant association between intraabdominal abscess formation and the OA cohort (OR 1.98, CI 1.25 – 3.14). However, no statistical difference was observed between the LOCA and LA cohorts with intraabdominal abscess formation (OR 0.97, CI 0.58 – 1.63).
Conclusion: Analysis of a contemporary national dataset showed laparoscopic appendectomy is associated with shorter LOS, less wound complications, and lower rates of postoperative abscess formation when compared to open appendectomy. This goes against historical comparisons of the two surgical techniques. The heterogeneity of studies demonstrates the need for randomized controlled trials to better elucidate the optimal management of complicated appendicitis.
