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Laparoscopic Versus Open Appendectomy: Outcomes Comparison Based on a Large Administrative Database

Guller, Ulrich MD, MHS*‡; Hervey, Sheleika BA; Purves, Harriett MPH, BS; Muhlbaier, Lawrence H. PhD§; Peterson, Eric D. MD, MPH; Eubanks, Steve MD*; Pietrobon, Ricardo MD‡∥

doi: 10.1097/01.sla.0000103071.35986.c1
Original Articles

Objective: To compare length of hospital stay, in-hospital complications, in-hospital mortality, and rate of routine discharge between laparoscopic and open appendectomy based on a representative, nationwide database.

Summary Background Data: Numerous single-institutional randomized clinical trials have assessed the efficacy of laparoscopic and open appendectomy. The results, however, are conflicting, and a consensus concerning the relative advantages of each procedure has not yet been reached.

Methods: Patients with primary ICD-9 procedure codes for laparoscopic and open appendectomy were selected from the 1997 Nationwide Inpatient Sample, a database that approximates 20% of all US community hospital discharges. Multiple linear and logistic regression analyses were used to assess the risk-adjusted endpoints.

Results: Discharge abstracts of 43,757 patients were used for our analyses. 7618 patients (17.4%) underwent laparoscopic and 36,139 patients (82.6%) open appendectomy. Patients had an average age of 30.7 years and were predominantly white (58.1%) and male (58.6%). After adjusting for other covariates, laparoscopic appendectomy was associated with shorter median hospital stay (laparoscopic appendectomy: 2.06 days, open appendectomy: 2.88 days, P < 0.0001), lower rate of infections (odds ratio [OR] = 0.5 [0.38, 0.66], P < 0.0001), decreased gastrointestinal complications (OR = 0.8 [0.68, 0.96], P = 0.02), lower overall complications (OR = 0.84 [0.75, 0.94], P = 0.002), and higher rate of routine discharge (OR = 3.22 [2.47, 4.46], P < 0.0001).

Conclusions: Laparoscopic appendectomy has significant advantages over open appendectomy with respect to length of hospital stay, rate of routine discharge, and postoperative in-hospital morbidity.

The objective of our investigation was to compare outcomes between laparoscopic and open appendectomy based on a large administrative database. Discharge abstracts of over 43,000 patients were used for this analysis. Laparoscopic appendectomy was found to have significant advantages over open appendectomy with respect to length of hospital stay, rate of routine discharge, and postoperative in-hospital morbidity.

From the *Department of Surgery, Duke University Medical Center, Durham, North Carolina; ‡Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, North Carolina; §Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina; ¶Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina; and ∥Division of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina.

Reprints: Ricardo Pietrobon, MD, Duke University Medical Center, Box 3094 Durham, NC 27710. E-mail: rpietro@duke.edu.

© 2004 Lippincott Williams & Wilkins, Inc.