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Should We Still Be Performing Open Appendectomies? a Comparison of Outcomes for Laparoscopic Versus Open Appendectomy With Data From the Canadian Institute for Health Information (CIHI)
Christopher Blackmore*, Divine Tanyingoh, Gilaad Kaplan, Elijah Dixon, Anthony R. Maclean, Chad G. Ball
University of Calgary, Calgary, AB, Canada
Background: Appendicitis is one of the most common surgical conditions in North America. Since the initial description of open appendectomy in 1894, little changed in surgical technique until 1983 with the development of the laparoscopic approach. Thirty years later, debate still exists as to the ideal technique for this disease. The objective of this study was to compare laparoscopic appendectomy (LA) to open appendectomy (OA) for the treatment of appendicitis in Canada.
Methods: Data was obtained from the Discharge Abstract Database within the Canadian Institute for Health Information (CIHI). All individuals admitted to a hospital across Canada for appendicitis (excluding Quebéc) between 2004 and 2008 were included. Patient demographics, morbidity and mortality were compared between patients who underwent laparoscopic and open appendectomies.
Results: From 2004 to 2008, 105,882 patients underwent appendectomy for appendicitis. Overall, 48.32% of appendectomies were laparoscopic. The odds of females undergoing LA were 1.26 times higher than males. The odds of a patient with a Charlson Comorbidity Index (CCI) of 0 undergoing LA were 1.35 times higher than patients with a CCI of 1 or higher. For patients with non-perforated appendicitis, the odds of undergoing LA were 1.38 times higher than patients with perforated appendicitis. The length of stay was significantly shorter for LA (2.37 days (SD 2.31)) compared to OA (3.44 (SD 3.48))(p <.0001). The post-operative complication rate (overall and intra-abdominal abscess, small bowel obstruction, paralytic ileus) was also significantly lower for LA compared to OA (3.16% vs. 5.33%, p <.0001), as was the mortality rate (0.03% vs. 0.10%, p =.0002). A statistically significant association was identified between the year of study and proportion of appendectomies performed laparoscopically (p <.0001), with a trend towards increasing rates of LA (35.6% in 2004 vs. 59% in 2008). Rates of LA also varied significantly across Canada (p <.0001), with higher rates in Pacific and Central Canada compared to Atlantic Canada.
Discussion: This study demonstrates an increasing trend towards LA for the treatment of acute appendicitis in Canada. While certain patient characteristics may influence the decision to choose LA or OA (patient age, sex, perforation), this data clearly supports the safety profile of LA. Overall, LA is associated with decreased morbidity, mortality and overall length of stay. This has significant economic implications.
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