Laparoscopic vs Open Appendectomy in Obese Patients: Outcomes Using the American College of Surgeons National Surgical Quality Improvement Program Database

Journal of the American College of Surgeons, 05/25/2012

In obese patients, laparoscopic appendectomy had superior clinical outcomes compared with open appendectomy after accounting for preoperative risk factors.

Methods

  • Using the American College of Surgeons National Surgical Quality Improvement Program database (2005–2009), 13,330 obese patients (body mass index ≥30) who underwent an appendectomy were identified (78% laparoscopic, 22% open).
  • The association between surgical approach (laparoscopic vs open) and outcomes was first evaluated using multivariable logistic regression.
  • Next, to minimize the influence of treatment selection bias, they created a 1:1 matched cohort using all 41 of the preoperative covariates in the National Surgical Quality Improvement Program database.
  • Reanalysis was then performed with the unmatched patients excluded.
  • Main outcomes measures included patient morbidity and mortality, operating room return, operative times, and hospital length of stay.

Results

  • Laparoscopic appendectomy was associated with a 57% reduction in overall morbidity in all the obese patients after the multivariable risk–adjusted analysis (odds ratio = 0.43; 95% CI, 0.36–0.52; p < 0.0001), and a 53% reduction in risk in the matched cohort analysis (odds ratio = 0.47; 95% CI, 0.32–0.65; p < 0.0001).
  • Mortality rates were the same. In the matched cohort, length of stay was 1.2 days shorter for obese patients undergoing laparoscopic appendectomy compared with open appendectomy (mean difference 1.2 days; 95% CI, 0.98–1.42).

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