title: Laparoscopic appendectomy significantly reduces length of stay for perforated appendicitis.
abstract: BACKGROUND
  Though ruptured appendicitis is not a contraindication to laparoscopic appendectomy (LA), most surgeons have not embraced LA as the first-line approach to ruptured appendicitis. In fact, in 2002, the Cochrane Database Review concluded: 1) the clinical effects of LA are "small and of limited clinical relevance," and 2) the effects of LA in perforated appendicitis require further study.
  
  
  OBJECTIVE
  To study the effects of LA vs open appendectomy (OA) among adults with appendicitis.
  
  
  METHODS
  In 2003, 272 adults underwent appendectomy at a large County hospital, and were enrolled in a prospective clinical pathway that detailed their hospital course from time of diagnosis to discharge. Data included patient demographics, time elapse from diagnosis to surgery, surgical technique (LA vs. OA), operative diagnosis (acute vs perforated appendicitis) and post-operative length of stay (LOS).
  
  
  RESULTS
  Complete data was obtained for 264 (97%) patients. Patient demographics were similar in the LA and OA groups (p > 0.05). Patients with LA had a significantly shorter LOS than OA by 1.6 days (p < 0.05). This LOS was significantly shorter among those with ruptured appendicitis vs. non-ruptured appendicitis (2.0 days vs. 0.3 day reduction, p = 0.0357). Rank-order multiple regression analysis, controlling for all other factors, showed laparoscopy to have a significant effect on postoperative LOS in all appendicitis cases, especially ruptured appendicitis.
  
  
  CONCLUSIONS
  The two-day reduction in LOS among those with ruptured appendicitis who underwent LA was significant enough to overcome the smaller benefit of LA in acute appendicitis. From a hospital utilization point of view, LA should be considered as the first-line approach for all patients with appendicitis.
authors.affiliation: Department of Surgery, University of Southern California, Los Angeles, CA 90089-9322, USA. stowfigh@surgery.usc.edu
authors.forename: S
authors.initials: S
authors.lastname: Towfigh
authors.forename: F
authors.initials: F
authors.lastname: Chen
authors.forename: R
authors.initials: R
authors.lastname: Mason
authors.forename: N
authors.initials: N
authors.lastname: Katkhouda
authors.forename: L
authors.initials: L
authors.lastname: Chan
authors.forename: T
authors.initials: T
authors.lastname: Berne
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002140:California; D019091:Critical Pathways; D016145:Endoscopy, Digestive System; D005260:Female; D006766:Hospitals, County; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies