David S Swedler, DO, Sharique Nazir, MD, Sharon B Larson, DO, MS, Jimmy Truong, DO, Jennifer M Caruana, DO, George S Ferzli, MD, FACS
Lutheran Medical Center,Brooklyn New york
Introduction
Appendectomy is the most common emergency surgery performed, but there still exists debate regarding the optimal management in the setting of an appendiceal abscess. The purpose of the study is to assess the utilization of laparoscopy and interval appendectomy in these cases. This information may elucidate how acute appendicitis is being managed in the community.
Methods
A retrospective study was performed over a five year period, 2007-2011, examining all patients who received an appendectomy, as defined by ICD codes Emergency department records, patient history and physical records, imaging studies, operative reports, pathology reports, and discharge summaries were included in this review. Interval and emergent study groups were established based on course of treatment at initial presentation and by the procedure coding.
Results
771 of 1115 patients met the criteria for the study. The mean age was 31.7 years. 646 patients (83.8%) presented with non-perforated appendicitis. followed by 86 cases (11.2%) of perforated appendicitis, 37 (4.8%) patients with an abscess, and 2 (0.3%) patients were classified as chronic appendicitis. 71% were performed laparoscopically, 22% open and 6.4% conversions. 750 (97.3%) patients were operated on emergently (EMER) while 21 (2.7%) were treated with an interval appendectomy (IA). 530 (71.0%) of EMER were completed using laparoscopy compared to 16 cases (76.2%) of IA (p=0.151). There were 46 (6.2%) conversions in the EMER group versus 3 (14.3%) conversions in IA group. Operative time, in minutes, for EMER was 78.9 compared to 68.5 for IA (p=0.123). The mean length of stay (LOS) for first hospitalization for the IA group was 5.3 days vs 2.48 days for the EMER group (p= 0.002). EMER patients were exposed to an average of 1 computed tomography (CT) scan compared to 2.2 CT scans in the IA group (p<0.001) A total of 37 out of 771 patients presented with an appendiceal abscess (4.8%). Of these, 28 (75.8%) were treated with EMER compared to 9 (24.3%) treated with IA. Laparoscopy was performed in 19 cases (55.9%), 14 were open (41.2%), and 1 case (2.9%) required conversion. The abscess group had an operative time of 74.4 min compared to all other presentations of 68.5 min (p=0.49). The abscess group had a longer cumulative LOS, 5.7 vs 2.6 days (p<0.001). Readmission rate for the abscess group (2.7%) was similar to the rest of the population (2.4%).
Conclusion
Laparoscopic surgery can be feasibly performed in the setting of an appendiceal abscess. The use of interval appendectomy is minimal at our institution, and has resulted in longer length of stay, more conversions, more radiology investigations, and no benefit in operative time when compared to emergent appendectomy. Given the numerous downfalls of interval appendectomy, we conclude all cases of acute appendicitis, regardless of presentation, can be treated with emergent, laparoscopic appendectomy.
Session: Poster Presentation
Program Number: P089
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