Systematic Review and Meta‐Analysis of Laparoscopic Versus Open Appendicectomy in Adults with Complicated Appendicitis: an Update of the Literature

Athanasiou, Christos; Lockwood, Sonia; Markides, G.

doi:10.1007/s00268-017-4123-3

Cited by 106 publications

(84 citation statements)

References 61 publications

(130 reference statements)

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“…Given the frequency of appendicitis, readmission has significant cost implications and the surgical community are increasingly recognizing the need to measure and improve outcomes . This meta‐analysis is one of the first to look at readmission, as previous meta‐analyses of patients undergoing appendectomy and appendicitis have focused on diagnosis, and surgical approaches, such as laparoscopic versus open techniques . While there may be a role for conservative management in some clinical situations, most patients currently will undergo surgery rather than non‐operative management of their appendicitis.…”

Section: Discussionmentioning

confidence: 99%

“…This study found that a laparoscopic approach to appendectomy was associated with fewer readmissions than with open surgery. A recent meta‐analysis of laparoscopic versus open appendectomy in adults with complicated appendicitis identified three randomized control trials and 24 case–control trials which, despite average methodological quality and low statistical heterogeneity, showed no significant difference in intra‐abdominal abscess rate with those undergoing laparoscopic approach . While operating time may be longer with a laparoscopic approach, the laparoscopic group had less surgical site infections and reduced time to resuming oral intake.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

Bailey

Choynowski

Kabir

et al. 2019

ANZ Journal of Surgery

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Background Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. While many studies report readmission, a meta‐analysis of readmission post‐appendectomy has not been published. This meta‐analysis was undertaken to determine rates and predictors of hospital readmission following appendectomy and to potentially provide a metric benchmark. Methods An ethically approved PROSPERO‐registered (ID CRD42017069040) meta‐analysis following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, using databases PubMed and Scopus, was undertaken for studies published between January 2012 and June 2017. Articles relating to outcomes and readmissions after appendectomy were identified. Those scoring >15 for comparative studies and >10 for non‐comparative studies, using Methodological Index for Non‐Randomized Studies criteria were included in the final analysis. The odds ratios (OR) using random‐effects, Mantel–Haenszel method with 95% confidence intervals (CI), were computed for each risk factor with RevMan5. Results A total of 1757 articles reviewed were reduced to 45 qualifying studies for a final analysis of 836 921 appendectomies. 4.3% (range 0.0–14.4%) of patients were readmitted within 30 days. Significant preoperative patient factors for increased readmission were diabetes mellitus (OR 1.93, CI 1.63–2.28, P < 0.00001), complicated appendicitis (OR 3.6, CI 2.43–5.34, P < 0.00001) and open surgical technique (OR 1.39, CI 1.08–1.79, P < 0.00001). Increased readmission was not associated with gender, obesity or paediatric versus general surgeons or centres. Conclusion This meta‐analysis identified that readmission is not uncommon post‐appendectomy, occurring in one in 25 cases. The mean readmission rate of 4.3% may act as a quality benchmark for improving emergency surgical care. Targeting high‐risk groups with diabetes or complicated appendicitis and increasing use of laparoscopic technique may help reduce readmission rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

Bailey

Choynowski

Kabir

et al. 2019

ANZ Journal of Surgery

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“…The highest predictors of post‐operative SSI were seen in individuals who had an open operation, and those who identified as ATSI. Evidence from multiple studies has demonstrated higher rates of SSI in patients who have an open compared to laparoscopic appendicectomy . Further subgroup analysis in our patient population showed that 69% of the converted to open cases were associated with complicated appendicitis.…”

Section: Discussionmentioning

confidence: 61%

Variation in anti‐microbial prescription and complications post emergency appendicectomy in Australia: do we follow recommended guidelines?

Thong

Kim

Dobson

et al. 2019

ANZ Journal of Surgery

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Background This study aims to establish compliance levels to prescription guidelines among Australian surgeons in the use of antibiotics in the surgical management of appendicitis. The secondary outcomes are predictors of post‐operative infective complications; surgical site infection (SSI) and intra‐abdominal abscess (IAA) at 30 days. Methods A multi‐centre, prospective, observational study was conducted over a period of 2 months with a 30‐day follow‐up. Patients were eligible for recruitment if they underwent appendicectomy for suspected appendicitis. Antibiotics prescription practices were recorded and compared to national guidelines. Results A total of 1189 patients were recruited across 27 centres; 1081 (92.1%) patients were given prophylactic antibiotics at the time of appendicectomy. Patients with gangrenous appendicitis were more likely to receive prophylactic antibiotics (98.9%); lower rates of use were seen in the non‐appendicitis group (85.7%). A total of 619 (53.3%) patients received antibiotics in the post‐operative period. Despite recommendations, 300 (44.3%) patients with simple appendicitis received post‐operative antibiotics. Only six (2.9%) patients with complicated appendicitis did not receive antibiotics. Overall, SSI and IAA rates were 1.9% and 2.7%, respectively. Aboriginal and Torres Strait Islanders (P = 0.02) and patients with converted operations (P = 0.001) were more likely to have a SSI. Patients with complicated appendicitis and those operated on by a consultant were more likely to increase the odds of IAA (odds ratio 3.8 and 5.1, respectively). Conclusion This broad‐based study shows mixed compliance with antibiotic guidelines in the surgical management of appendicitis in Australia. The use of post‐operative antibiotics in patients with simple appendicitis should be a target for antimicrobial stewardship programmes to prevent antibiotic over‐utilization.

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“…Complicated appendicitis, defined as the presence of acute appendicitis with peritonitis, rupture, gangrene, or intra‐abdominal abscess, accounts for 14% to 55% of all appendicitis cases . Laparoscopic treatment for uncomplicated appendicitis has already demonstrated its superiority over the open approach in terms of perioperative outcomes …”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] Laparoscopic treatment for uncomplicated appendicitis has already demonstrated its superiority over the open approach in terms of perioperative outcomes. [6][7][8] The current treatment strategy for both uncomplicated and complicated appendicitis varies from emergency operations to non-operative management (NOM). NOM involves the administration of antibiotic drugs with or without percutaneous drainage and then an interval appendectomy (IA).…”

Section: Introductionmentioning

confidence: 99%

Superior outcomes (but at higher costs) of non‐operative management with interval appendectomy over immediate surgery in appendicitis with abscess: Results from a large adult population cohort

Watanabe

Otsuji

Nakamura

et al. 2019

Asian J Endoscop Surgery

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Introduction The aim of this study was to compare surgical outcomes and hospitalization costs between immediate surgery and non‐operative management followed by interval appendectomy in adults presenting with appendicitis with abscess. Methods From 2003 to 2015, 3316 patients presented with appendicitis, including 101 who presented with appendicular abscess. Between 2003 and 2006, 33 patients with appendicular abscess were managed with emergency operations (emergency group). Non‐operative management followed by interval appendectomy was implemented in 2007 and offered to 68 patients during the study period. Of these patients, 64 patients underwent the procedure (interval group), and 4 patients refused. Results Non‐operative management was successful in 76.6% of cases (49/64 patients) in the interval group. Operative time and length of hospital stay were similar between the emergency and interval groups. In the interval group, blood loss, the need for extended resection, and overall postoperative morbidity were significantly lower than in the emergency group (P < 0.01, respectively). Medical costs for surgery in the interval group were lower than in the emergency group ($4512 vs $6888, P = 0.002), but this group's total medical costs were higher ($9591 vs $6888, P < 0.01). Conclusion The interval strategy is associated with a reduced need for extended resection, lower postoperative morbidity, and a shorter length of hospital stay. However, total medical costs for the interval strategy are higher than those for emergency operations in cases of appendicular abscess in adults.

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Systematic Review and Meta‐Analysis of Laparoscopic Versus Open Appendicectomy in Adults with Complicated Appendicitis: an Update of the Literature

Abstract: LA appears to have significant benefits with improved morbidity compared to OA in complicated appendicitis (level of evidence II).

Cited by 106 publications

References 61 publications

Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

Variation in anti‐microbial prescription and complications post emergency appendicectomy in Australia: do we follow recommended guidelines?

Superior outcomes (but at higher costs) of non‐operative management with interval appendectomy over immediate surgery in appendicitis with abscess: Results from a large adult population cohort

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