title: Patient and surgeon factors are associated with the use of laparoscopy in appendicitis.
abstract: OBJECTIVE
  The use of a minimally invasive approach to treat appendicitis has yet to be universally accepted. The objective of this study was to examine recent trends in Ireland in the surgical management of acute appendicitis.
  
  
  METHODS
  Data were obtained from the Irish Hospital In-Patient Enquiry system for patients discharged with a diagnosis of appendicitis between 1999 and 2007. An anonymous postal survey was sent to all general surgeons of consultant and registrar level in Ireland to assess current attitudes to the use of laparoscopic appendectomy.
  
  
  RESULTS
  The use of laparoscopic appendectomy increased throughout the study and was the most common approach for appendectomy in 2007. Multivariate analysis revealed age under 50 years (OR = 1.51), female sex (OR = 2.84) and residence in high-density population areas (OR = 4.15) as predictive factors for undergoing laparoscopic appendectomy in the most recent year of the study. While 97% of surgeons reported current use of laparoscopy in patients with acute right iliac fossa pain, in most cases it was selective. Surgeons in university teaching hospitals (42 of 77; 55%) were more likely to report using laparoscopic appendectomy for all cases of appendicitis than those in regional (six of 23; 26%) or general (13 of 53; 25%) hospitals (P = 0.048).
  
  
  CONCLUSIONS
  This study has demonstrated a significant increase in laparoscopic appendectomy, yet a variety of patient and surgeon factors contribute to the choice of procedure. Differences in the perception of benefit of the laparoscopic approach amongst surgeons appears to be an important factor in determining the operative approach for appendectomy.
authors.affiliation: Department of Surgery, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: D P
authors.initials: DP
authors.lastname: McCartan
authors.forename: F J
authors.initials: FJ
authors.lastname: Fleming
authors.forename: A D K
authors.initials: AD
authors.lastname: Hill
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001062:Appendectomy / Q000379:methods / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000601:surgery*; D001291:Attitude of Health Personnel; D005260:Female; D013502:General Surgery; D006769:Hospitals, General; D006784:Hospitals, Teaching; D006801:Humans; D007494:Ireland; D010535:Laparoscopy / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires