Laparoscopic versus open appendectomy: an analysis of outcomes in 17,199 patients using ACS/NSQIP.

Background: The current study was undertaken to evaluate the outcomes for open and laparoscopic appendectomy using the 2008 American College of Surgeons: National Surgical Quality Improvement Program (ACS/NSQIP) Participant Use File (PUF). We hypothesized that laparoscopic appendectomy would have fewer infectious complications, superior perioperative outcomes, and decreased morbidity and mortality when compared to open appendectomy.

Study Design: Using the Current Procedural Technology (CPT) codes for open (44950) and laparoscopic (44970) appendectomy, 17, 199 patients were identified from the ACS/NSQIP PUF file that underwent appendectomy in 2008. Univariate analysis with chi-squared tests for categorical data and t tests or ANOVA tests for continuous data was used. Binary logistic regression models were used to evaluate outcomes for independent association by multivariable analysis.

Results: Of the patients, 3,025 underwent open appendectomy and 14,174 underwent laparoscopic appendectomy. Patients undergoing laparoscopic appendectomy had significantly shorter operative times and hospital length of stay. They also had a significantly lower incidence of superficial and deep surgical site infections, wound disruptions, fewer complications, and lower perioperative mortality when compared to patients undergoing open appendectomy.

Conclusions: Using the ACS/NSQIP PUF file, we demonstrate that laparoscopic appendectomy has better outcomes than open appendectomy for the treatment of appendicitis. While the operative treatment of appendicitis is surgeon specific, this study lends support to the laparoscopic approach for patients requiring appendectomy.