Outcomes of Laparoscopic versus Open Appendectomy in the Setting of Coagulopathy Using the ACS-NSQIP Database
Ya Zhou1, Vida Rastegar2, Mazen Al-Mansour3
1Department of Surgery, University of Massachusetts Medical School - Baystate, Springfield, MA 2Epidemiology and Biostatistics Research Core, University of Massachusetts Medical School - Baystate, Springfield, MA 3Department of Surgery, University of Florida, Gainesville, FL
Background: Laparoscopic appendectomy (LA) is the most common approach for the management for acute appendicitis in the United States. Patients with coagulopathy requiring emergent appendectomy constitute a challenging population. We studied the outcomes of open appendectomy (OA) and LA in patients with coagulopathy using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
Methods: Using ACS-NSQIP, we identified adult patients who underwent emergent appendectomy from 2014-2017. Patients were stratified into those with and without coagulopathy. Primary outcomes were postoperative transfusions and 30-day reoperation. Propensity for LA versus OA was estimated on 23 pretreatment variables using augmented inverse probability of treatment weights (AIPW). Two models compared the adjusted risk of adverse outcomes based on procedure type in patients with and without coagulopathy.
Results: A total of 7,049 patients with coagulopathy and 130,380 without coagulopathy were included. There was no difference in adjusted risk of either primary outcome between OA and LA in the coagulopathy group. However, LA was associated with shorter operative time (56.6 vs. 74.6 minutes), shorter LOS (3.66 vs. 5.09 days) and lower SSI rate (6.06 vs. 9.88%) compared to OA. Among patients with coagulopathy, 784 patients (11.1%) underwent OA and 6,265 (88.9%) underwent LA. LA was performed less often in coagulopathic patients (88.9 vs 94.1%).
Conclusion: LA in coagulopathic patients is associated with shorter operative times, LOS and SSI rate compared to OA. The rate of postoperative transfusions and reoperation were similar. LA should be strongly considered in this high-risk patient population.
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