Laparoscopic appendectomy preferable for obese patients

Jul 10 2012

By Sarah Guy

Obese patients with appendicitis have fewer postoperative complications, a shorter stay in hospital, and shorter operative times when treated with laparoscopic appendectomy rather than open appendectomy, study findings show.

Mortality rates among obese patients treated with either surgical method did not differ significantly, report the researchers.

The results emerge from data recorded between 2005 and 2009 in the American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) database that showed that a quarter of patients undergoing appendectomies during this timeframe and who had available body mass index (BMI) calculations were obese (BMI ≥30).

"Appendectomy is one of the most common surgical procedures," write Rodney Mason and colleagues from the University of Southern California, Keck School of Medicine in Los Angeles, USA.

"With obesity rates in the United States exceeding 30% of the population, it is important that we identify appendectomy techniques that reduce length of stay (LOS) and morbidity in the obese patient," they add, in the Journal of the American College of Surgeons.

The team assessed 30-day outcomes (including overall morbidity, serious morbidity, and mortality) after appendectomy in 13,330 obese patients registered in the ACS NSQIP. Of these patients, 78% received laparoscopic surgery.

In all, 938 (7.0%) of patients experienced any morbidity, 504 (4.0%) experienced a serious morbidity, and 28 (0.2%) patients died during the 30 days after appendectomy, write Mason et al.

After adjustment for factors including age, smoking and drinking status, and comorbidities including diabetes, laparoscopic surgery reduced the risk for overall morbidity and serious morbidity by a significant 57% and 46%, respectively. Conversely, there was no significant difference in mortality outcomes by surgery type.

Furthermore, the associations with laparoscopic surgery remained when the researchers categorized the obese cohort into obese, morbidly obese (BMI ≥40), and super morbidly obese (BMI ≥50) status.

Owing to the nonrandom assignment of surgical approach to these patients, Mason and co-workers conducted a subanalysis using Coarsened Exact Matching procedure to reduce bias.

The researchers found that overall LOS in hospital was a significant 1.2 days shorter in obese patients treated with laparoscopic appendectomy than those who underwent open appendectomy, and operative time in these former patients was a significant 11 minutes shorter.

"We've shown a shorter length of stay. There's the cost savings right there," commented Mason in an associated press release.

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