Laparoscopic vs. Open Appendectomy in Morbidly Obese Patients (bmi>40): A NSQIP Analysis

Muhammad Asad Khan, MD, Roman Grinberg, MD, Stelin Johnson, RPAC, John N Afthinos, MD, Karen E Gibbs, MD. Staten Island University Hospital

BACKGROUND:

Morbid obesity has become a major global health problem and, as such, treating common surgical problems must factor this into determining best care practices. Laparoscopic appendectomy is commonly employed as a treatment modality for acute appendicitis and offers potentially decreased morbidity and mortality in single institution studies. However, there is still an ongoing debate whether laparoscopic appendectomy offers any benefits in morbidly obese patients. The aim of this study is to compare the outcomes of this subset of patients undergoing open versus laparoscopic appendectomy.

METHOD:
Morbidly obese patients (BMI ≥ 40 kg/m2) undergoing open and laparoscopic appendectomy for non-ruptured appendicitis were identified from American College of Surgery – National Surgical Quality Improvement program (ACS-NSQIP) database using CPT- codes. Preoperative co-morbidities, operative time, length of hospitalization and perioperative mortality and morbidity were compared between the two groups using chi-square and independent t-test as appropriate. A p-value of 0.05 or less was considered statistically significant.

RESULTS:
A total of 1,976 patients were identified between the year 2007 and 2009 with a mean age of 40 ± 14 years with 61% being female. A laparoscopic appendectomy was performed on 1,643 (83.1%) patients. The patients in the laparoscopic group were younger (40 ± 14 years vs. 43 ± 14 years, p <.001), had a lower prevalence of hypertension (35% vs. 43%), diabetes (14.7% vs. 21.3%) and have had fewer percutaneous coronary revascularizations (1.7% vs. 4.2%). The operative time in laparoscopic group was 61 ± 34 minutes which was significantly shorter than the open group (81.6 ± 45 minutes). The length of stay was also shorter in the laparoscopic group (2.1 ± 2.7 days vs. 4.2 ± 5.4 days). The laparoscopic group had fewer postoperative superficial and deep surgical wound infections and a lower rate of pulmonary complications including a decreased need for reintubation and failure to wean from the ventilator (Table). There was no difference in mortality between the two groups.

CONCLUSION:
Open appendectomy in morbidly obese patients is associated with significantly increased risk of surgical wound infections and respiratory complications. Laparoscopic appendectomy should be attempted in all morbidly obese patients to potentially avoid these complications.
 

View Poster