Risk of complications and 30-day mortality after laparoscopic and open appendectomy in a Danish region, 1998-2007; a population-based study of 18,426 patients

Abstract

Acute appendicitis is the most common abdominal surgical emergency, but population-based data on the risk of complications after laparoscopic appendectomy (LA) and open appendectomy (OA) are scarce.

The aim of the study: To describe the risk of complications and mortality after appendectomy for acute appendicitis during a 10-year period, and to compare outcomes after LA and OA.

Material and methods: Using population-based registry data, we conducted a historical cohort study in a Danish region (population 2,000,000) including all patients who underwent appendectomy for acute appendicitis during the period of 1998-2007. We used logistic regression to compare the risk of complications and 30-day mortality between LA and OA, adjusting for gender, age, severity of appendicitis, time of surgery, and calendar year. Analyses were stratified for severity of appendicitis and time period.

Results: We included 18,426 patients. From 1998 to 2007 the use of LA rose from 12% to 61%, while the risk of surgically-treated complications fell from 5.7% to 3.2%, the risk of intra-abdominal infections fell from 2.4% to 1.1% and 30-day mortality fell from 0.30% to 0.23%. LA was associated with a lower risk of surgically-treated complications (adjusted odds ratio for LA vs. OA=0.70 (95% CI, 0.57-0.85), intraabdominal infections (OR=0.74 [95% CI, 0.55-0.99]) and mortality (OR=0.48 [95% CI, 0.18-1.30]). LA was safer than OA for simple and complicated appendicitis throughout the study period.

Conclusions: Risk of complications and 30-day mortality decreased in Denmark between 1998 and 2007 concurrently with implementation of LA. The risk of complications was lower after LA than after OA.