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Meta-Analysis
. 2022 Mar;46(3):531-541.
doi: 10.1007/s00268-021-06373-0. Epub 2022 Jan 6.

Mortality Following Appendicectomy in Patients with Liver Cirrhosis: A Systematic Review and Meta-Analysis

Adil Rashid  1 , Alisha Gupta  2 , Alfred Adiamah  3 , Joe West  4 , Matthew Grainge  4 , David J Humes  3   4
Affiliations
Meta-Analysis

Mortality Following Appendicectomy in Patients with Liver Cirrhosis: A Systematic Review and Meta-Analysis

Adil Rashid et al. World J Surg. 2022 Mar.

Abstract

Introduction: With the global prevalence of liver cirrhosis rising, this systematic review aimed to define the perioperative risk of mortality in these patients following appendicectomy.

Methods: Systematic searches of Medline, EMBASE, Cochrane Library databases, ICTRP, and Clinical trials.gov were undertaken to identify studies including patients with cirrhosis undergoing appendicectomy, published since database inception to March 2021. Studies had to report mortality. Two review authors independently identified eligible studies and extracted data. Pooled analysis of in-patient and 30-day mortality was performed.

Results: Of the 948 studies identified, four were included and this comprised three nationwide database studies (USA and Denmark) and one multi-centre observational study (Japan). A total of 923 patients had cirrhosis and 167,211 patients did not. In-patient mortality ranged from 0 to 1.7% in patients with cirrhosis and 0.17 to 0.3% in patients without. 30-day mortality was 9% in patients with cirrhosis compared to 0.3% in those without. One study stratified cirrhotic patients into compensated and decompensated groups. In patients with compensated cirrhosis, mortality following laparoscopic appendicectomy (0.5%) was significantly lower than open appendicectomy (3.2%). The meta-analysis highlighted a tenfold increase in perioperative mortality in cirrhotic patients (OR 9.92 (95% CI 4.67 to 21.06, I2 = 28%). All studies reported an increased length of stay in patients with cirrhosis.

Conclusion: This review suggests that appendicectomy in the cirrhotic population is associated with increased mortality. LA may be safer in this population. Lack of information on cirrhosis severity and failure to control for age and co-morbidities make the results difficult to interpret. Further large population-based studies are required.

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Conflict of interest statement

None of the authors have any conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
PRISMA 2009 Flow Diagram
Fig. 2
Fig. 2
Meta-analysis of the mortality following appendicectomy in patients with and without liver cirrhosis
Fig. 3
Fig. 3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
See this image and copyright information in PMC

Comment in

References

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