How Do Community Hospitals Compare to University Hospitals in the Surgical Management of Perforated Appendicitis?

Anna L Goldenberg, DO, Robert A Ramirez, DO, Marc Rosen, DO FACOS, James Weese, MD FACS, Roy L Sandau, DO. Kennedy University Hospital, NJ

 Introduction: 

Appendicitis is the most commonly encountered surgical cause of an acute abdomen. Immediate appendectomy has long been the standard treatment for acute appendicitis because of the known progression to perforation. Perforated appendicitis has a higher rate of complications, which include but are not limited to surgical site infections, abscess, peritonitis, sepsis and death. 

Laparoscopic appendectomy (LA) is a minimally invasive procedure that offers advantages over the traditional open appendectomy (OA) including smaller incisions, visualization of the peritoneal cavity, and a presumed reduction of recovery time. [10]

Methods:

A 10 year retrospective analyses of patients who had a diagnosis of perforated appendicitis at Kennedy Memorial Hospitals in Southern New Jersey from January 1998 through December 2008 were analyzed. Patient information was entered into a database. Procedures included laparoscopic, open and laparoscopic converted to open.  The information on each patient included age, sex, weight, comorbidities, complications of surgery(s), time of surgery(s), white blood cell count preoperatively (on admission), white blood cell count post-operatively, post-operative complications, additional procedures, readmission and length of hospitalization. Comparisons between the three groups will be made using Microsoft Excel ANOVA single factor analysis for variance and a p<0.05 was considered statistical significant.  IRB approval was obtained prior to commencing the data collection.  An OVID on-line literature review was conducted and our results were then compared to larger tertiary university based hospitals.

Results:

Preliminary data gathered from January 1998 through December 2008 was performed.  A total of 245 medical records met the aforementioned criteria.

·  Laparoscopic treatment reduced the length of hospitalization, rate of overall complication, rate of wound infections, and rate of readmission. P<0.05

·  There was no advantage in operative time between laparoscopic versus open groups.  However, both were less than converted procedures.  P<0.05

·  Laparoscopic treatment did not change the rate of additional procedures; p=0.13

·  The rate of intra-abdominal abscess was similar between the laparoscopic and open groups.  However, there was less for the converted group. P=0.69 

Conclusion:

This study shows that in cases of perforated appendicitis length of hospitalization, overall complication rate, wound infection rate, and rate of readmission is lower in the LA group.  There also is no difference in the operative time, rate of intra-abdominal infection or additional procedures.  This data supports laparoscopic appendectomy when faced with perforation.

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