Comparison of outcomes of laparoscopic versus open appendectomy in adults: data from the Nationwide Inpatient Sample (NIS), 2006-2008

Abstract

Introduction: Although laparoscopic appendectomy (LA) is being performed with increased frequency, the utilization of laparoscopy in the management of acute appendicitis remains controversial, and it continues to be used selectively.

Objectives: This study aims to evaluate outcomes of LA vs. open appendectomy (OA) in perforated and non-perforated appendicitis in adults.

Methods: Using the Nationwide Inpatient Sample database, clinical data of adults who underwent LA and OA for suspected acute appendicitis were evaluated from 2006 to 2008. Incidental and elective appendectomies were excluded.

Results: A total of 573,244 adults underwent urgent appendectomy during these 3 years. Overall, 65.2% of all appendectomies were performed laparoscopically. Utilization of LA increased 23.7% from 58.2% in 2006 to 72.0% in 2008. In acute non-perforated appendicitis, LA had a lower overall complication rate (4.13% vs. 6.39%, p < 0.01), lower in-hospital mortality (0.03% vs. 0.05%, p < 0.01), and shorter mean length of hospital stay (LOS; 1.7 vs. 2.4 days, p < 0.01) compared with OA; however, hospital charges were higher in the LA group ($22,948 vs. $20,944, p < 0.01). Similarly, in perforated appendicitis, LA was associated with a lower overall complication rate (18.75% vs. 26.76%, p < 0.01), lower in-hospital mortality (0.06% vs. 0.31%, p < 0.01), lower mean hospital charges ($32,487 vs. $38,503, p < 0.01), and shorter mean LOS (4.0 vs. 6.0 days, p < 0.01) compared with OA.

Conclusion: LA is safe and associated with lower morbidity, lower mortality, and shorter hospital stay with acute perforated and non-perforated appendicitis. Also, in perforated cases, LA had an advantage over OA in hospital charges. LA should be considered the procedure of choice for perforated and non-perforated appendicitis in adults.