title: Use of failure modes, effects, and criticality analysis to compare the vulnerabilities of laparoscopic versus open appendectomy.
abstract: OBJECTIVE
  To measure the feasibility of using FMECA applied to the surgery and then compare the vulnerabilities of laparoscopic versus open appendectomy by using FMECA.
  
  
  METHODS
  The FMECA study was performed on each single selected phase of appendectomy and on complication-related data during the period January 1, 2009, to December 31, 2010. The risk analysis phase was completed by evaluation of the criticality index (CI) of each appendectomy-related failure mode (FM). The CI is calculated by multiplying the estimated frequency of occurrence (O) of the FM, by the expected severity of the injury to the patient (S), and the detectability (D) of the FM.
  
  
  RESULTS
  In the first year of analysis (2009), 177 appendectomies were performed, 110 open and 67 laparoscopic. Eleven adverse events were related to the open appendectomy: 1 bleeding (CI: 8) and 10 postoperative infections (CI: 32). Three adverse events related to the laparoscopic approach were recorded: 1 postoperative infection (CI: 8) and 2 incorrect extractions of the appendix through the umbilical port (CI: 6). In the second year of analysis (2010), 158 appendectomies were performed, 69 open and 89 laparoscopic. Four adverse events were related to the open appendectomy: 1 incorrect management of the histological specimen (CI: 2), 1 dehiscence of the surgical wound (CI: 6), and 2 infections (CI: 6). No adverse events were recorded in laparoscopic approach.
  
  
  CONCLUSIONS
  FMECA helped the staff compare the 2 approaches through an accurate step-by-step analysis, highlighting that laparoscopic appendectomy is feasible and safe, associated with a lower incidence of infection and other complications, reduced length of hospital stay, and an apparent lower procedure-related risk.
authors.affiliation: From the *Pediatric Surgery Department, Giannina Gaslini Institute, University of Genoa; †Quality Control Office, Giannina Gaslini Institute; and ‡DINOGMI, Pediatric Department, Giannina Gaslini Institute, University of Genoa, Genoa, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Guida
authors.forename: Ubaldo
authors.initials: U
authors.lastname: Rosati
authors.forename: Alessio
authors.initials: A
authors.lastname: Pini Prato
authors.forename: Stefano
authors.initials: S
authors.lastname: Avanzini
authors.forename: Luca
authors.initials: L
authors.lastname: Pio
authors.forename: Michele
authors.initials: M
authors.lastname: Ghezzi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Jasonni
authors.forename: Girolamo
authors.initials: G
authors.lastname: Mattioli
mesh_terms: D001062:Appendectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D001064:Appendicitis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome