Introduction: The national trend towards outpatient or short stay surgery and the development and acceptance of laparoscopic surgery have led to shorter lengths of stay (LOS) after many surgical procedures. Appendectomy serves as a good example of this trend, and numerous publications compare open and laparoscopic appendectomy LOS. Less clear, however, is whether shorter hospitalizations following appendectomy are driven by the increased use of laparoscopic techniques, or the general movement towards more rapid mobilization and discharge of surgical patients
Methods: Hospital discharge records from the Commission on Professional and Hospital Activity (CPHA) and the computerized medical records of a single community teaching hospital were used to develop a database of medical and LOS data from January, 1974 through November 2006.
Results:A total of 3741 appendectomies were identified over that 33 year period. There were 3508 open appendectomies and 233 laparoscopic appendectomies. The first laparoscopic appendectomy at this institution was performed in 1997. The general preference of the operating surgeons at this institution has remained for open appendectomy. In 2006 only 28% of appendectomies were performed laparoscopically.The data demonstrate a statistically significant decrease in LOS from 8.02 days (+/- 1.14) in 1978 to 2.30 days (+/- 0.38) in 2006. There was a precipitous decline in LOS from 1992 to 1994. There was a statistically significant difference between open (3.07 +/- 0.15 days) and laparoscopic appendectomy (1.84 +/- 0.28 days) over the period 1997-2006. Looking only at open appendectomy over the period 1974 to 2006, there was still a significant decline in LOS from 8 to 3 days. The steep decline in LOS from 1992 to 1994 was again observed.
Conclusion: This large retrospective study of appendectomy demonstrated a significant decline in LOS over the 32 year study period. The precipitous decline in LOS in the period 1992-1994 coincides with the rise of the short stay movement in surgery, and does not correlate with the onset of laparoscopic appendectomy at this institution, which occurred 4 years later. There is a significant difference in LOS between open and laparoscopic appendectomy, but further study of severity of illness and comorbidity is ongoing to determine whether this played a role in these data.