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Unplanned Readmission After Appendectomy
Zhobin Moghadamyeghaneh*, Mark H. Hanna, Joseph C. Carmichael, Steven Mills, Alessio Pigazzi, Michael J. Stamos
Surgery, University of California, Irvine, Orange, CA
Background
Unplanned readmission of patients who undergo appendectomy is a relatively frequent occurrence, particularly considering the size of the overall patient population. We sought to report the incidence, most common reasons, and predictors of unplanned readmission within 30 days of operation following appendectomy.
Method
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was used to examine the clinical data of patients undergoing emergent/urgent appendectomy with a diagnosis of acute appendicitis in 2012. Multivariate regression analysis was performed to identify the predictors of unplanned readmission.
Results
We evaluated 15,394 patients who underwent appendectomy. Of these, 2754 (17.9%) of patients had perforated appendicitis. Overall, 539 (3.5%) of patients had an unplanned readmission. The most common indication for unplanned readmission was intra-abdominal infection (36.7%), nonspecific pain (5.5%) and paralytic ileus (5%). With multivariate analysis, the most important predictor of unplanned readmission was pregnancy (AOR: 5.02, P<0.01) followed by chronic pulmonary disease (COPD) (AOR: 3.14, P=0.01), diabetes (AOR: 2.25, P<0.01), and preoperative sepsis (AOR: 1.60, P<0.01). Patients who were hospitalized more than two days had a higher risk of unplanned readmission (AOR: 1.63, P=0.03). Patients with perforation had a significantly higher risk of unplanned readmission compared to patients without perforation and complications (peritonitis or abscess) (AOR: 1.64, p=0.02).
Conclusion
Overall, 3.5% of patients who underwent emergent appendectomy had an unplanned readmission to the hospital within 30 days of operation. Pregnant patients have the highest risk of postoperative readmission. Also, patients with preoperative sepsis, SIRS, septic shock or comorbidities of COPD and diabetes have increased risk of postoperative readmission. Importantly, perforated appendicitis increases the risk of unplanned readmission to hospital. Intra-abdominal infections followed by nonspecific pain and paralytic ileus are the most common reasons for readmission.
Table 1: Reasons of unplanned readmission after appendectomy (NSQIP 2012)
| Readmission Reason | Number(%) | | Organ space surgical site infection | 158(30.2%) | | Nonspecific pain | 29(5.5%) | | Ileus | 26(5%) | | Superficial surgical site infection | 20(3.8%) | | Hematoma | 13(2.5%) | | Myocardial infarction | 9(1.7%) | | Pneumonia | 6(1.1%) | | Fever | 6(1.1%) | | Progressive renal insufficiency | 5(1%) | | Sepsis | 4(0.8%) | | Pulmonary embolism | 3(0.6%) | | Wound disruption | 2(0.4%) | | Deep vein thrombosis | 2(0.4%) | | Urinary tract infection | 2(0.4%) | | Septic shock | 1(0.2%) | | Other reasons | 238(45.5%) |
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