Surgical approach, cost, and complications of appendectomy in kidney transplant recipients

Abstract

Kidney transplant recipients (KTRs) have greater morbidity and length of stay (LOS) following certain surgical procedures than non-KTR. Given that appendectomy is one of the most common surgical procedures, we investigated differences in outcomes between 1336 KTR and 2 640 247 non-KTR postappendectomy at transplant and nontransplant centers in the United States from 2000 to 2011, using NIS data and adjusting for patient-level and hospital-level factors. Postoperative complications were identified using ICD-9 codes. Among KTR, there were no post-appendectomy in-hospital deaths, compared to a 0.2% in non-KTR (P = .5). Overall complications were similar among KTR and non-KTR (17.0% vs 11.6%; aOR:_0.77 1.12_1.61 ). LOS and costs were greater for KTR compared to non-KTR (LOS ratio _1.19 1.31_1.45 ; cost ratio _1.11 1.17_1.26 ). Only 44.8% of KTR had laparoscopic approach compared to 54.5% of non-KTR, but had similar complication rates (10.6 vs 8.7%, P = .5). When treated at transplant centers, KTR had similar complications (aOR _0.44 0.79_1.43 ), but longer LOS (ratio _1.21 1.37_1.55 ) and greater hospital-associated costs (ratio _1.19 1.29_1.41 ) than non-KTR. Conversely, at nontransplant centers, KTR and non-KTR had similar complications (aOR _0.75 1.23_2.0 ), LOS (ratio _0.84 0.96_1.09 ), and cost (ratio _0.93 1.01_1.10 ). Contrary to other procedures, KTR did not constitute a high-risk group for patients undergoing appendectomy.

Keywords: appendectomy; general surgery; kidney transplantation.