2021 Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Las Vegas, Nevada, 31 August–3 September 2021

2021 Surgical Endoscopy  
Appendectomy remains the principal management for acute appendicitis with reported morbidity and mortality of 5.5-14.5% and 0.03-0.24%, respectively. This study examines the profile and outcome of appendectomy in veterans over two decades. Methods: Cases of appendectomy in the VASQIP database between 1999-2019 were identified. Appendectomies performed for cancer, interval appendectomy, or as part of another major operation were excluded. Demographics, clinical/operative details, and outcomes of
more » ... open (OA) and laparoscopic (LA) appendectomies were compared along with trend analysis over that period. A p \ 0.05 was considered significant. Results: A total of 12,006 cases were identified (91.1% male, mean age 52.3, mean BMI 29.5, 50.3% with ASA C 3, and 95.8% functionally independent). Mean operative time (OT) was 1.2 h, and 65.7% were performed within first 24 h. There were 40 (0.33%) mortalities and complications occurred in 8.8%). Mean length of stay (LOS) was 3.5 days. OA was performed in 29.9% and LA in 70.1%. Compared to OA, LA group were younger (51.2 vs. 54.9, p \ 0.001), more males (93.7% vs. 89.9%, p \ 0.001), with lower ASA class C 3 (47.9% vs. 56.0%, p \ 0.001), more functional independent (96.5% vs.94.1%, p \ 0.001), and less frail (Frailty index ? 2) (18.7% vs. 27.2%, p \ 0.001). LA was less likely to performed within first 24 h (61.9% vs. 74.2%, p \ 0.001), less in patients with sepsis (4.5% vs. 8.4%, p \ 0.001), and had shorter OT (1.2 h vs. 1.3 h, p \ 0.001), shorter LOS (2.7 days vs. 5.1 days, p \ 0.001), lower morbidity (6.2% vs. 14.9%, p \ 0.001) and lower mortality (0.18% vs. 0.7%, p \ 0.001). Sepsis (OR 2.2, p \ 0.001), dependent functional status (OR 1.6, p = 0.001), frailty index [ 1 (OR 1.3, p \ 0.001) and current smoking status (OR 1.2, p = 0.015) were independent predictors of morbidity, while chronic steroid use (OR 14.8, p \ 0.001), preoperative sepsis (OR 4.9, p \ 0.001), and age C 65 (OR 4.5, p \ 0.001) were independent factors of mortality. Laparoscopy had a protective effect on both morbidity (OR 0.4, p \ 0.001), and mortality (OR 0.3, p \ 0.001). Trend analysis showed improvement in morbidity and LOS, (C-statistics 19.1, p \ 0.001 and C-statistics 11.1, p \ 0.001, respectively), increase in LA (C-statistics 69.3, p \ 0.001) by 56%, and drop of the total number of appendectomies by 70%. Conclusion: Compared nationally, LA performed at comparable rate with similar outcomes in veterans and is superior to OA. Recent trends show declining number of appendectomies, improving outcome, and increased application of laparoscopy.
doi:10.1007/s00464-021-08748-9 pmid:34734304 pmcid:PMC8565855 fatcat:bhx2qaano5fzffyqfzhwk5mry4