Matthew M Symer1, Jonathan S Abelson1, Art Sedrakyan2, Heather L Yeo3. 1. NewYork-Presbyterian Hospital / Weill Cornell Medicine, Department of Surgery, New York, NY, USA. 2. Weill Cornell Medicine, Department of Healthcare Policy and Research, New York, NY, USA. 3. NewYork-Presbyterian Hospital / Weill Cornell Medicine, Department of Surgery, New York, NY, USA; Weill Cornell Medicine, Department of Healthcare Policy and Research, New York, NY, USA. Electronic address: Hey9002@med.cornell.edu.
Abstract
BACKGROUND: There is no consensus on the ideal management of complicated appendicitis. METHODS: The New York State Planning and Research Cooperative database was used to identify all patients admitted with complicated appendicitis and undergoing appendectomy within 1-year. Primary outcome was any complication. Secondary outcomes included length of stay (LOS), hospital charges, and laparoscopy use. Outcomes were compared in appendectomy before or after 48h from admission. RESULTS: 31,167 patients ≥18yo were identified for analysis, 28,015(89.9%) underwent early appendectomy. Early appendectomy patients were more likely to be White (69.8% vs. 64.2% p < 0.01), and commercially insured (53.1% vs. 45.4%, p < 0.01). Of the 3152 undergoing delayed surgery, 1610(51.1%) had surgery later during the index admission, 715(22.7%) were readmitted urgently and underwent appendectomy, and 827(26.2%) had elective appendectomy. Patients undergoing delayed surgery had more complications (OR 1.34 95%CI 1.23-1.45), readmissions (OR 1.55 95%CI 1.42-1.70), high hospital charges (OR 4.79 95%CI 4.35-5.27), and prolonged LOS (OR 6.12 95%CI 5.61-6.68). CONCLUSIONS: In this population-level study of complicated appendicitis we found more complications, longer LOS, and higher charges in patients undergoing delayed surgery.
BACKGROUND: There is no consensus on the ideal management of complicated appendicitis. METHODS: The New York State Planning and Research Cooperative database was used to identify all patients admitted with complicated appendicitis and undergoing appendectomy within 1-year. Primary outcome was any complication. Secondary outcomes included length of stay (LOS), hospital charges, and laparoscopy use. Outcomes were compared in appendectomy before or after 48h from admission. RESULTS: 31,167 patients ≥18yo were identified for analysis, 28,015(89.9%) underwent early appendectomy. Early appendectomy patients were more likely to be White (69.8% vs. 64.2% p < 0.01), and commercially insured (53.1% vs. 45.4%, p < 0.01). Of the 3152 undergoing delayed surgery, 1610(51.1%) had surgery later during the index admission, 715(22.7%) were readmitted urgently and underwent appendectomy, and 827(26.2%) had elective appendectomy. Patients undergoing delayed surgery had more complications (OR 1.34 95%CI 1.23-1.45), readmissions (OR 1.55 95%CI 1.42-1.70), high hospital charges (OR 4.79 95%CI 4.35-5.27), and prolonged LOS (OR 6.12 95%CI 5.61-6.68). CONCLUSIONS: In this population-level study of complicated appendicitis we found more complications, longer LOS, and higher charges in patients undergoing delayed surgery.
Authors: Nikolaos G Symeonidis; Efstathios T Pavlidis; Kyriakos K Psarras; Kalliopi Stavrati; Christina Nikolaidou; Alexandra Marneri; Georgios Geropoulos; Maria Meitanidou; Emili Andreou; Theodoros E Pavlidis Journal: Surg Res Pract Date: 2022-03-31