Vemuru Sunil K Reddy, MD, Syed S Razi, MD, Benson Ku, Umashankkar Kannan, MD, Mukerji Amarnath, MD, Mohan M John, MD, Ajay K Shah, MD, FACS, Daniel Farkas, MD, FACS, Brian F Gilchrist, MD, FACS. Bronx Lebanon Hospital Center, 1650 Grand Concourse, Bronx, NY- 10457
Laparoscopic appendectomy has been shown to decrease postoperative length of stay as compared to open appendectomy in the management of acute appendicitis. Computerized Tomography (CT) is increasingly being used as an adjunct in the diagnosis of acute appendicitis. An appendix with thickness greater than 7 mm is generally suggestive of acute appendicitis. However, size of the appendix and its impact on duration of surgery, postoperative length of stay and postoperative complications has not been well characterized in prior studies.
Retrospective chart review was done for 316 patients who underwent emergent laparoscopic appendectomy in a community hospital for acute appendicitis between August 2009 and May 2013. CT scan was used to measure the wall thickness and outer diameter of the inflamed appendix. Independent-samples t-test was used for univariate analyses. Multinomial logistic regression was used to study the strength of association between covariates and size of the inflamed appendix.
Mean age of the patients was 33.4 ± 0.87 years. The mean outer diameter of the appendix was 12.04 ± 0.18 mm. Average postoperative length of stay was 2.8 ± 0.34 days. However in patients with appendix ≥ 14.0 mm, length of stay significantly increased to 4.8 ± 1.2 days. Size of the appendix (≥ 14.0 mm) remained an independent risk factor for prolonged postoperative hospitalization in multivariate analysis (HR 1.25, 95% CI 1.01 – 1.56; p = 0.04). However size of the appendix was not associated with an increase in the duration of surgery (HR 0.993, 95% CI 0.980 – 1.006; p = 0.31).
The postoperative hospital length of stay following laparoscopic appendectomy significantly increases when the thickness of appendix approaches 14 mm or more.