Tailoring the operative approach for appendicitis to the patient: a prediction model from national surgical quality improvement program data.
BACKGROUND
Laparoscopic appendectomy (LA) is increasingly being performed in the United States, despite controversy about differences in infectious complication rates compared with open appendectomy (OA). Subpopulations exist in which infectious complication rates, both surgical site and organ space, differ with respect to LA compared with OA.


METHODS
All appendectomies in the National Surgical Quality Improvement Program database were analyzed with respect to surgical site infection (SSI) and organ space infection (OSI). Multivariate logistic regression analysis identified independent predictors of SSI or OSI. Probabilities of SSI or OSI were determined for subpopulations to identify when LA was superior to OA.


RESULTS
From 2005 to 2009, there were 61,830 appendectomies performed (77.5% LA), of which 9,998 (16.2%) were complicated (58.7% LA). The risk of SSI was considerably lower for LA in both noncomplicated and complicated appendicitis. Across all ages, body mass index, renal function, and WBCs, LA was associated with a lower probability of SSI. The risk of OSI was considerably greater for LA in both noncomplicated and complicated appendicitis. In complicated appendicitis, OA was associated with a lower probability of OSI in patients with WBC >12 cells × 10(3)/μL. In noncomplicated appendicitis, OA was associated with a lower probability of OSI in patients with a body mass index <37.5 when compared with LA.


CONCLUSIONS
Subpopulations exist in which OA is superior to LA in terms of OSI, however, SSI is consistently lower in LA patients.
Division of General Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA. lara.senekjian@hsc.utah.edu
Lara
L
Senekjian
Raminder
R
Nirula
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000379:methods* / Q000592:standards; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058996:Quality Improvement; D012372:ROC Curve; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D014481:United States; D055815:Young Adult