Laparoscopic vs. Open Appendectomy in Obese Patients

Muhammad Asad Khan, MD, Roman Grinber, MD, Stelin Johnson, RPAC, Johan N Afthinos, MD, Karen E Gibbs, MD. Staten Island University hospitals

 

INTRODUCTION:
Prevalence of obesity in adults older than 20 years of age is 34%. Although laparoscopic surgery has been widely adapted as the standard of the care, it is still unclear if it is superior to the open approach in obese (BMI ≥ 30) patients. Information from administrative databases and single institutions are available but have inherent deficiencies. The aim of our study is to assess the risk profile of contemporary patients being treated with open repair and to compare outcomes among open vs. laparoscopic appendectomy patients.

METHODS:
Patients who underwent appendectomy for non-perforated appendicitis between 2007 and 2009 were identified from ACS-NSQIP, which is a multicenter, comprehensive, prospectively maintained database with more than 180 participating hospitals. Laparoscopic and open techniques were compared. Preoperative comorbidities, operative duration, and 30-day outcomes were evaluated using t-tests or chi-squared test as appropriate.

Results:
A total of 12,532 patients were identified and 2,057 (16.4%) patients underwent open repair. The mean age of the study population was 41.6 ± 15 years. The open repair group had a higher risk profile in terms of increased frequency of diabetes (11.5% vs. 8.5%), chronic pulmonary disease (2% vs. 1%), chronic heart failure (0.5% vs. 1%), history of percutaneous cardiac revascularization (4.3% vs. 2.0%), hypertension (32.3% vs. 26.5%) and symptomatic peripheral vascular disease (0.6 vs. 0.2%) compared to the laparoscopic group. Operative time and length of hospitalization were significantly greater in the open group (67.8 ± 39 min vs. 55.1 ± 28 min and 3.3 ± 4.8 days vs. 1.6 ± 2.2 days). Thirty day mortality was higher in the open group (0.3% vs. 0.1%) and more patients required re-operation (2.5% vs. 1.3%). The rate of surgical site infection including superficial, deep and surgical wound dehiscence was higher in the open group. More patients in the open group had significant postoperative morbidity including pneumonia, ARF, failure to wean from the ventilator, re-intubation, DVT, sepsis, septic shock and cardiac arrest (Table).

CONCLUSION: Open appendectomy in patients with BMI > 30 is associated with significantly higher morbidity and mortality. Laparoscopic appendectomy offers significant benefits and should be employed in this population.
 

Complications

Open Appendectomy

N=2057

Laparoscopic Appendectomy

N=10475

P value
Perioperative complications
Pneumonia 16 (0.8%) 41 (0.4%) <.001
Failure to wean 21 (1.0%)  19 (0.2%)  <.001
Reintubation 18 (0.9%) 28 (0.3%) <.001
Acute renal failure  6 (0.3%)  6 (0.1%)  .007
Urinary tract infection  22 (1.1%)  0 (0.5%)  .003
Cardiac arrest  4 (0.2%)  5 (0.04%)  .046
DVT  8 (0.4%)  9 (0.1%)  .001
Sepsis  38 (1.8%)  112 (1.1%)  .004
Septic shock  11 (0.5%)  19 (0.2%)  .006

 


Session Number: Poster – Poster Presentations
Program Number: P487
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