Appendectomy for Appendicitis Has Worse Hospital Outcomes in Inflammatory Bowel Disease Patients

Abstract

Background and Aims: Appendectomy is the choice of surgery for appendicitis but little is known about its outcomes in patients with Inflammatory Bowel Disease (IBD). We sought to compare hospital outcomes of appendectomy for appendicitis between patients with and without IBD. Methods: This is a cross-sectional study utilizing the Nationwide Inpatient Sample between 2009 and 2013. Patients with appendicitis undergoing appendectomy were identified using appropriate International Classification of Diseases codes. Primary outcomes of interest included length of stay (LOS), hospital costs, and post-surgical complications. Univariate and multivariate analyses were used to compare these outcomes between patients with and without IBD. Results: A total of 849,312 patients with appendicitis undergoing appendectomy were included in this study, of which 4261 patients had IBD. IBD patients had longer LOS and increased hospital costs. Crohn’s disease (CD) patients were more likely to develop post-operative pulmonary embolism (adjusted odds ratio (aOR) 7.06, 95% Confidence Interval (CI) (2.19, 22.79)) and anemia (aOR 2.23, 95% CI (1.21, 4.10)), whereas ulcerative colitis patients were more likely to develop post-operative deep vein thrombosis (aOR 9.79, 95% CI (2.41, 39.75)). CD patients were more likely to have perforated ap-pendicitis (aOR 1.37, 95% CI (1.67, 1.11)) and open appendectomy (aOR 1.56, 95% CI (1.96, 1.27)). Conclusions: Appendectomy for appendicitis in IBD patients is associated with adverse hospital outcomes. Focused attempts are needed to decrease the risk of DVT and PE in these patients. Treating patient’s pre-surgical anemia and proactive venous thromboembolism prophylaxis in IBD patients undergoing appendectomy for appendicitis might improve hos-pital outcomes.