Risk of complications and 30-day mortality after laparoscopic and open appendectomy in a Danish region, 1998-2007; a population-based study of 18,426 patients.
Acute appendicitis is the most common abdominal surgical emergency, but population-based data on the risk of complications after laparoscopic appendectomy (LA) and open appendectomy (OA) are scarce.


OBJECTIVE
To describe the risk of complications and mortality after appendectomy for acute appendicitis during a 10-year period, and to compare outcomes after LA and OA.


METHODS
Using population-based registry data, we conducted a historical cohort study in a Danish region (population 2,000,000) including all patients who underwent appendectomy for acute appendicitis during the period of 1998-2007. We used logistic regression to compare the risk of complications and 30-day mortality between LA and OA, adjusting for gender, age, severity of appendicitis, time of surgery, and calendar year. Analyses were stratified for severity of appendicitis and time period.


RESULTS
We included 18,426 patients. From 1998 to 2007 the use of LA rose from 12% to 61%, while the risk of surgically-treated complications fell from 5.7% to 3.2%, the risk of intra-abdominal infections fell from 2.4% to 1.1% and 30-day mortality fell from 0.30% to 0.23%. LA was associated with a lower risk of surgically-treated complications (adjusted odds ratio for LA vs. OA=0.70 (95% CI, 0.57-0.85), intraabdominal infections (OR=0.74 [95% CI, 0.55-0.99]) and mortality (OR=0.48 [95% CI, 0.18-1.30]). LA was safer than OA for simple and complicated appendicitis throughout the study period.


CONCLUSIONS
Risk of complications and 30-day mortality decreased in Denmark between 1998 and 2007 concurrently with implementation of LA. The risk of complications was lower after LA than after OA.
Sidse
S
Bregendahl
Mette
M
Nørgaard
Søren
S
Laurberg
Peter
P
Jepsen
D001062:Appendectomy / Q000401:mortality*; D001064:Appendicitis / Q000401:mortality* / Q000601:surgery; D016001:Confidence Intervals; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000401:mortality; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality*; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome