Outcomes of Laparoscopic and Open Appendectomy for Acute Appendicitis in Patients with Acquired Immunodeficiency Syndrome

Abstract

The aims of this study were to compare outcomes of appendectomy between acquired immunodeficiency syndrome (AIDS) and nonAIDS patients and laparoscopic appendectomy (LA) versus open appendectomy (OA) in AIDS patients. Using the Nationwide Inpatient Sample database, from 2006 to 2008, clinical data of patients with AIDS who underwent LA and OA were evaluated. A total of 800 patients with AIDS underwent appendectomy during these years. Patients with AIDS had a significantly higher postoperative complication rate (22.56% vs 10.36%), longer length of stay [(LOS) 4.9 vs 2.9 days], and higher mortality (0.61% vs 0.16%) compared with non-AIDS patients. In nonperforated cases in patients with AIDS, LA was associated with a significantly lower complication rate (11.25% vs 21.61%), lower mortality (0.0% vs 2.78%), and shorter mean LOS (3.22 days vs 4.82 days) compared with OA. In perforated cases in patients with AIDS, LA had a significantly lower complication rate (27.52% vs 57.50%), and shorter mean LOS (5.92 days vs 9.67 days) compared with OA. No mortality was reported in either group. In patients with AIDS, LA has a lower morbidity, lower mortality, and shorter LOS compared with OA. Laparoscopic appendectomy should be considered as a preferred operative option for acute appendicitis in patients with AIDS.

A Study Comparing Outcomes of Appendectomy between HIV-Infected and HIV-Negative Patients

“…SSI was the most common complication and septic shock was documented in a single patient. These findings are in keeping with previous studies that have investigated the effect of HIV on appendicitis (5)(6)(7)(8). In spite of these correlations, the impact of the HIV pandemic on surgical outcomes remains controversial; there are no prospective trials in the current literatureand most retrospective studies are small and yielded conflicting results (1,(22)(23)(24).…”

“…Post appendectomy, the HIV+ patients stayed longer in hospital (7.28 vs. 5.95 days, P=0.004); an observation made by two large national database studies previously (7,8). The length of hospital stay in this study relates mainly to the post-operative complications of SSIs and persistent pyrexia.…”

“…Previous authors have ascribed this operative approach to the high rate of perforation and peritonitis, that occurdue to the delay in presentation of these patients (4,6). The morbidity relates predominantly to Surgical Site Infections, and is reduced with a laparoscopic approach (7,8). The post-operative morbidity was higher in those infected with the virus (38.9% vs. 14.7%, P=0.03) in this study.…”

“…Opportunistic infections such as Tuberculosis (TB) and AIDS-related malignancies such as Kaposi's Sarcoma (KS) and lymphoma will frequently mimic the clinical presentation of appendicitis. Whilst an appendectomy will assist the surgeon in confirming the diagnoses and direct further therapy, the associated post-operative morbidity and mortality are concerning (1,(4)(5)(6)(7)(8)(9).…”

Surgery during the COVID-19 pandemic

“…3 However, for abdominal surgery, the use of laparoscopy substantially reduced postoperative morbidity, mortality, and hospital stay in patients with AIDS. 4 Currently, there is a debate on whether to use the laparoscopic approach in patients with COVID-19 because of the possible risk of aerosol transmission from surgical smoke. This risk remains hypothetical.…”