Abstract Category: Research
Purpose: Acute appendicitis affects over 5% of the United States population and may occur at any age. Considering the high prevalence of appendectomy within the United States, it is important for a uniform treatment protocol to be established. One important controversy within appendectomy is the time of surgery, as the literature shows varying outcomes. The objective of this study was to determine if there is an association between same day vs. next day laparoscopic appendectomies and adverse outcomes in hospitalized adult men and women in the United States in 2016.
Methods: This was a retrospective cohort study conducted through secondary data analysis of the American College of Surgeons National Surgical Quality Improvement Program of 33,799 patients who had laparoscopic appendectomies in the United States in 2016. The main independent variable was timing of laparoscopic appendectomy and main dependent variable was adverse outcome. Multivariate logistic regression analysis was conducted to assess the association between timing of appendectomy and adverse outcome.
Findings: Of 33,799 patients, 25,916 patients underwent same day appendectomy while 7,460 patients had next day appendectomy. The two primary outcomes of the study were post op infection and readmission/reoperation. Adjusted analysis showed next day appendectomy had 1.07 times (CI 1.01-1.14) the risk of infection and 1.15 times (CI 0.96-1.37) the risk for readmission/reoperation compared to same day surgery. Females had 10% (CI 1.04-1.16) increased risk of infection but decreased risk for reoperation/readmission by 17% (CI 0.71-0.97). Hispanic patients had a 19% decreased risk (CI 0.75-0.88) of infection as well as a 26% decreased risk for reoperation/readmission (CI 0.57-0.95).
Discussion: This study demonstrates that timing of appendectomy is associated with both infection and readmission/reoperation. Next day appendectomy showed slight increase risk for both outcomes. Of interest, female gender had increased risk of infection, but female gender and Hispanic patients had lower risk of readmission/reoperation. Hispanic patients had decreased risks of infection and readmission/reoperation. Study limitations include potential errors and missing data from medical records as well as a limited sample of patients needing reoperation/readmission.
Implications for Practice: Ideally, future research should focus on identifying the exact time interval of hospital arrival to time of surgery to minimize risk of adverse outcomes. Identifying the risk profile of a patient who presents with appendicitis aids in providing appropriate treatment as well as ameliorating complications.
2018 West Kendall Baptist Hospital Scholarly Showcase
FIU Herbert Wertheim College of Medicine Affiliates, "Operative Outcomes in Same Day vs. Next Day Laparoscopic Appendectomies" (2018). All Publications. 2735.
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