Laparoscopic appendectomy found safe

Laparoscopic appendectomy (LA) is safe, carrying low rates of complications, readmission and prolonged length of stay (LOS), a recent study has found. Risk factors for these adverse outcomes include complicated appendicitis and intraoperative complications.

The study included 4,618 patients (median age, 33 years; 52.2 percent male) qualified for laparoscopic appendectomy. Majority (69.60 percent; n=3,214) belonged to class I of the American Society of Anaesthesiologists classification. Acute appendicitis symptoms presented within 48 hours of surgery in 31.68 percent of the patients.

A total of 310 patients experienced postoperative morbidity, resulting in a rate of 6.71 percent. In terms of complications, there were reports of surgical site infections, intra-abdominal abscesses and bleeding, pneumonia, urinary tract infection, bowel perforation, pulmonary embolism, and deep vein thrombosis.

Multivariate logistic regression analysis found that the occurrence of intraoperative adverse events (odds ratio [OR], 4.09, 95 percent confidence interval [CI], 1.32–12.65; p=0.014) and complicated appendicitis (OR, 3.63, 95 percent CI, 1.74–7.61; p=0.001) were significant predictors of perioperative serious complications.

In comparison, predictors of prolonged LOS included complicated appendicitis (OR, 2.8, 95 percent CI, 1.53–5.12; p=0.001), postoperative morbidity (OR, 5.01, 95 percent CI, 2.33–10.75; p<0.001), conversion of procedure (OR, 6.48, 95 percent CI, 3.48–12.08; p<0.001) and the need for reinterventions after the primary procedure (OR, 8.79, 95 percent CI, 3.2–24.14; p<0.001).

Hospital readmission were predicted by postoperative complications (OR, 10.33, 95 percent CI, 4.27–25.00), undergoing reinterventions after the procedure (OR, 5.62, 95 percent CI, 2.17–14.54) and LA performed by the resident (OR, 1.96, 1.03–3.70).