Scientific papers
Trends in utilization and outcomes of laparoscopic versus open appendectomy

Presented at the 56th Annual Meeting of the Southwestern Surgical Congress, Monterey, California, April 18–21, 2004
https://doi.org/10.1016/j.amjsurg.2004.08.047Get rights and content

Abstract

Background

Although a number of trials have analyzed the outcomes of laparoscopic versus open appendectomy, the clinical advantages, and cost-effectiveness of laparoscopic appendectomy in the management of acute and perforated appendicitis are still not clearly defined. The aim of this study was to examine utilization and outcomes of laparoscopic versus open appendectomy using a national administrative database of academic medical centers and teaching hospitals.

Methods

Using ICD-9 diagnosis and procedure codes, we obtained data from the University HealthSystem Consortium Clinical Data Base for all patients who underwent appendectomy for acute and perforated appendicitis between 1999 and 2003 (n = 60,236). Trends in utilization of laparoscopic appendectomy were examined over the 5-year period. The outcomes of laparoscopic and open appendectomy were compared including length of hospital stay, 30-day readmission, complications, observed and expected (risk-adjusted) in-hospital mortality, and costs.

Results

Overall, 41,085 patients underwent open appendectomy and 19,151 patients underwent laparoscopic appendectomy. The percentage of appendectomy performed by laparoscopy increased from 20% in 1999 to 43% in 2003 (P <0.01). Compared with patients who underwent open appendectomy, patients who underwent laparoscopic appendectomy were more likely female, more likely white, had a lower severity of illness, and were less likely to have perforated appendicitis. Laparoscopic appendectomy was associated with a shorter length of hospital stay (2.5 days vs 3.4 days), lower rate of 30-day readmission (1.0% vs 1.3%), and lower rate of overall complications (6.1% vs 9.6%). There was no significant difference in the observed to expected mortality ratio between laparoscopic and open appendectomy (0.5 vs 0.6, respectively). The mean cost per case was similar between the two groups ($6,242 vs $6,260).

Conclusions

Utilization of laparoscopic appendectomy at academic centers has increased more than two-fold between 1999 and 2003. Patients selected for laparoscopic appendectomy have less advanced appendicitis and have a shorter length of stay and fewer complications without increasing the inpatient care cost.

Section snippets

Database

Administrative data of patients who underwent open or laparoscopic appendectomy from 1999 to 2003 were obtained from the University HealthSystem Consortium (UHC) Clinical Data Base. The UHC database is a collection of patient-level all-payer hospital UB-92 and discharge abstract data from academic health centers and affiliate community hospitals and contains discharge information on inpatient hospital stay such as patient characteristics (age, sex, and race), postoperative length of stay,

Results

From 1999 to 2003, a total of 60,236 patients underwent laparoscopic or open appendectomy for the treatment of acute and perforated appendicitis at 129 academic institutions in the United States. As shown in Table 1, there were 126 institutions performing laparoscopic appendectomy (n = 19,151) and 129 institutions performing open appendectomy (n = 41,085). The mean number of laparoscopic appendectomies done annually at each institution was 30, and the mean number of open appendectomies done

Comments

Although the accepted treatment for acute and perforated appendicitis is appendectomy, the optimal technique for appendectomy is still unclear. Multiple comparative studies and prospective randomized trials comparing laparoscopic versus open appendectomy have been reported; yet, the clinical advantages and cost-effectiveness of laparoscopic appendectomy are still not clearly defined [6], [7], [8], [9], [10], [11]. Despite the mixed results of these studies, the utilization of laparoscopic

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  • Cited by (128)

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