Laparoscopic appendectomy significantly reduces length of stay for perforated appendicitis |
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Authors: | S Towfigh F Chen R Mason N Katkhouda L Chan T Berne |
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Institution: | (1) Department of Surgery, University of Southern California, 1200 North State Street, Room 9900, Los Angeles, CA 90089-9322, USA |
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Abstract: | Introduction Though ruptured appendicitis is not a contraindication to laparoscopic appendectomy (LA), most surgeons have not embraced
LA as the first-line approach to ruptured appendicitis. In fact, in 2002, the Cochrane Database Review concluded: 1) the clinical
effects of LA are “small and of limited clinical relevance,” and 2) the effects of LA in perforated appendicitis require further
study.
Objective To study the effects of LA vs open appendectomy (OA) among adults with appendicitis.
Methods In 2003, 272 adults underwent appendectomy at a large County hospital, and were enrolled in a prospective clinical pathway
that detailed their hospital course from time of diagnosis to discharge. Data included patient demographics, time elapse from
diagnosis to surgery, surgical technique (LA vs. OA), operative diagnosis (acute vs perforated appendicitis) and post-operative
length of stay (LOS).
Results Complete data was obtained for 264 (97%) patients. Patient demographics were similar in the LA and OA groups (p > 0.05). Patients with LA had a significantly shorter LOS than OA by 1.6 days (p < 0.05). This LOS was significantly shorter among those with ruptured appendicitis vs. non-ruptured appendicitis (2.0 days
vs. 0.3 day reduction, p = 0.0357). Rank-order multiple regression analysis, controlling for all other factors, showed laparoscopy to have a significant
effect on postoperative LOS in all appendicitis cases, especially ruptured appendicitis.
Conclusions The two-day reduction in LOS among those with ruptured appendicitis who underwent LA was significant enough to overcome the
smaller benefit of LA in acute appendicitis. From a hospital utilization point of view, LA should be considered as the first-line
approach for all patients with appendicitis. |
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Keywords: | Clinical paper Appendix appendicitis laparoscopic appendectomy appendectomy perforated appendicitis |
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