Risk of complications and 30-day mortality after laparoscopic and open appendectomy in a Danish region, 1998-2007; a population-based study of 18,426 patients
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Acute appendicitis is the most common abdominal surgical emergency, but population-based data on the risk of complications after laparoscopic appendectomy (LA) and open appendectomy (OA) are scarce.The aim of the study was to describe the risk of complications and mortality after appendectomy for acute appendicitis during a 10-year period, and to compare outcomes after LA and OA.Material and methods. Using population-based registry data, we conducted a historical cohort study in a Danish region (population 2,000,000) including all patients who underwent appendectomy for acute appendicitis during the period of 1998-2007. We used logistic regression to compare the risk of complications and 30-day mortality between LA and OA, adjusting for gender, age, severity of appendicitis, time of surgery, and calendar year. Analyses were stratified for severity of appendicitis and time period.Results. We included 18,426 patients. From 1998 to 2007 the use of LA rose from 12% to 61%, while the risk of surgically-treated complications fell from 5.7% to 3.2%, the risk of intra-abdominal infections fell from 2.4% to 1.1% and 30-day mortality fell from 0.30% to 0.23%. LA was associated with a lower risk of surgically-treated complications (adjusted odds ratio for LA vs. OA=0.70 (95% CI, 0.57-0.85), intraabdominal infections (OR=0.74 [95% CI, 0.55-0.99]) and mortality (OR=0.48 [95% CI, 0.18-1.30]). LA was safer than OA for simple and complicated appendicitis throughout the study period.Conclusions. Risk of complications and 30-day mortality decreased in Denmark between 1998 and 2007 concurrently with implementation of LA. The risk of complications was lower after LA than after OA
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- 1. Ohmann C, Franke C, Kraemer M et al.: Status report on epidemiology of acute appendicitis. Chirurg 2002, 73:769-76.
- 2. Addiss DG, Shaffer N, Fowler BS et al.: The epidemiology of appendicitis and appendectomy in the United States. Amer J Epidemiol 1990; 132: 910-25.
- 3. Nguyen NT , Zainabadi K, Mavandadi S et al.: Trends in utilization and outcomes of laparoscopic versus open appendectomy. Am J Surg 2004; 188: 813-20.
- 4. Paterson HM, Qadan M, de Luca SM et al.: Changing trends in surgery for acute appendicitis.
- Br J Surg 2008; 95: 363-68.
- 5. Katkhouda N, Mason RJ, Towfigh S et al.: Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg 2005; 242: 439-48; discussion 448-50.
- 6. Pedersen AG, Petersen OB, Wara P et al.: Randomized clinical trial of laparoscopic versus open appendicectomy. Br J Surg 2001; 88: 200-05.
- 7. Hellberg A, Rudberg C, Kullman E et al.: Prospective randomized multicentre study of laparoscopic versus open appendicectomy. Br J Surg 1999; 86: 48-53.
- 8. Ignacio RC, Burke R, Spencer D et al.: Laparoscopic versus open appendectomy: what is the real difference? Results of a prospective randomized doubleblinded trial. Surg Endosc 2004; 18: 334-37.[Crossref]
- 9. Heikkinen TJ, Haukipuro K, Hulkko A: Cost-effective appendectomy. Open or laparoscopic? A prospective randomized study. Surg Endosc 1998; 12: 1204-08.[PubMed][Crossref]
- 10. Moberg AC, Berndsen F, Palmquist I et al.: Randomized clinical trial of laparoscopic versus open appendicectomy for confirmed appendicitis. Br J Surg 2005; 92: 298-304.
- 11. Caravaggio C, Hauters P, Malvaux P et al.: Is laparoscopic appendectomy an effective procedure? Acta Chirurgica Belgica 2007; 107: 368-72.
- 12. Paik PS, Towson JA, Anthone GJ et al.: Intra- Abdominal Abscesses Following Laparoscopic and Open Appendectomies. J Gastrointestinal Surg 1997; 1: 188-93.
- 13. Pokala N, Sadhasivam S, Kiran RP et al.: Complicated appendicitis - is the laparoscopic approach appropriate? A comparative study with the open approach: outcome in a community hospital setting. Am Surg 2007; 73: 737-41; discussion 741-42.
- 14. Wullstein C, Barkhausen S, Gross E: Results of laparoscopic vs. conventional appendectomy in complicated appendicitis. Dis Colon Rectum 2001; 44: 1700-05.
- 15. Yau KK , Siu WT , Tang CN et al.: Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg 2007; 205: 60-65.
- 16. Katkhouda N, Friedlander MH, Grant SW et al.: Intraabdominal abscess rate after laparoscopic appendectomy. Am J Surg 2000; 180: 456-59.
- 17. Sauerland S, Jaschinski T, Neugebauer EA : Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2010; (10): CD001546.[WoS][Crossref]
- 18. Bennett J, Boddy A, Rhodes M: Choice of approach for appendicectomy: A meta-analysis of open versus laparoscopic appendicectomy. Surgical Laparoscopy,Endoscopy and Percutaneous Techniques 2007; 17: 245-55.[WoS][Crossref]
- 19. Sporn E, Petroski GF, Mancini GJ et al.: Laparoscopic appendectomy - is it worth the cost? Trend analysis in the US from 2000 to 2005. J Am CollSurg 2009; 208: 179-85.e2.
- 20. Bisset AF: Appendicectomy in Scotland: A 20- year epidemiological comparison. J of Public HealthMedicine 1997; 19: 213-18.[PubMed]
- 21. Blomqvist PG, Andersson RE B, Granath F et al.: Mortality after appendectomy in Sweden, 1987-1996. Ann Surg 2001; 233: 455-60.
- 22. Faiz O, Clark J, Brown T et al.: Traditional and laparoscopic appendectomy in adults: outcomes in English NHS hospitals between 1996 and 2006. Ann Surg 2008; 248: 800-06.[WoS]
- 23. Guller U, Hervey S, Purves H et al.: Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. AnnSurg 2004; 239: 43-52.
- 24. Rothman KJ, Greenland S, Lash TL : Modern Epidemiology, Lippincott Williams and Wilkins 2008.
- 25. Ekeh AP, Wozniak CJ, Monson B et al.: Laparoscopy in the contemporary management of acute appendicitis. Am J Surg 2007; 193: 310-13; discussion 313-14.
- 26. Esposito C, Borzi P, Valla JS et al.: . Laparoscopic versus open appendectomy in children: a retrospective comparative study of 2,332 cases. World J Surg 2007; 31: 750-55.[WoS]
- 27. Gagne JP, Billard M, Gagnon R et al.: Province- wide population survey of acute appendicitis in Canada. New twists to an old disease. Surg Endosc 2007; 21: 1383-87.[WoS][PubMed][Crossref]
- 28. Brugger L, Rosella L, Candinas D et al.: Improving outcomes after laparoscopic appendectomy: a population-based, 12-year trend analysis of 7446 patients. Ann Surg 2011; 253: 309-13.[WoS]
- 29. Park HC, Yang DH, Lee BH: The laparoscopic approach for perforated appendicitis, including cases complicated by abscess formation. J LaparoendoscAdv Surg Tech 2009; A. 19: 727-30.[WoS]
- 30. Mancini GJ, Mancini ML, Nelson HS: Efficacy of laparoscopic appendectomy in appendicitis with peritonitis. Am Surg 2005; 71: 1-4; discussion 4-5.
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