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Outcomes of Open Versus Laparoscopic Appendectomy in the United States, 1998-2002

Maksim Zayaruzny, Liam Haveran, Shauna Malone, Stephen P Baker, Demetrius E. M. Litwin
UMASS, Worcester, MA

Objective: Compare outcomes between open and laparoscopic appendectomy based on the data from a representative nationwide administrative database.
Design: Retrospective review of the Nationwide Inpatient Sample (NIS) database for 1998-2002.
Setting: Results are generalizable to all US non-federal acute care hospitals.
Patients: Patients were identified based on the appropriate ICD-9 diagnostic codes for the primary procedure during the index admission. Weighted analysis yielded an estimated 1,213,110 appendectomies.
Main Outcome Measures: Primary outcome measures were in-hospital mortality, in-hospital complications, and length of stay.
Results: After adjusting for co-morbidities, including diabetes, hypertension, chronic renal failure, COPD, and patient demographics, laparoscopic appendectomy was associated with lower in-hospital mortality (OR 0.48, [0.31, 0.74] p<0.0001), shorter length of stay (3.37 vs. 2.41 days, p<0.0001), lower risk of postoperative infectious complications (OR 0.61 [0.55, 0.68] p<0.0001), and pulmonary complications (OR 0.9 [0.82, 0.99] p=0.026). Laparoscopic appendectomy was associated with increased risk of postoperative fever (OR 1.1 [1.01, 1.21] p=0.036) and bleeding during the procedure (OR 2.6 [2.1, 3.1] p<0.0001), but no increase in risk of perioperative blood transfusions (OR 0.94 [0.81 1.1] p=0.38).
Conclusion: This observational study of a large patient population suggests that laparoscopic appendectomy confers several advantages over open appendectomy, including reductions in mortality, length of stay, and post-operative infectious and pulmonary complications. Laparoscopic appendectomy is associated with increased risk of intra-operative bleeding, but this does not appear to increase the likelihood of transfusion.

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