The contemporary appendectomy for acute uncomplicated appendicitis in adults

Abstract

Epidemiologic data related to the surgical management of appendicitis are out of date. As we contemplate the role of nonoperative therapy in uncomplicated appendicitis, a contemporary profile of the risks and benefits of operative appendectomy is needed. This study merged the 2016 National Surgical Quality Improvement Program essential and appendectomy-targeted participant use files. The appendectomy-targeted file provides procedure-specific variables related to imaging, approach, and outcomes. Epidemiologic data were generated across five domains for adults with uncomplicated appendicitis: patient characteristics/severity, imaging patterns, operative characteristics, pathologic outcomes, and postoperative morbidity/mortality. The merged data file contained 12,376 adult appendectomies from 115 National Surgical Quality Improvement Program sites. After exclusions, 7,778 cases were analyzed. Almost all patients (96.1%) received preoperative imaging, with most (79.2%) receiving a computed tomography scan only. Only 2.6% of appendectomies were performed open, and the laparoscopic to open conversion rate was 0.5%. Most patients (87.3%) were discharged the day of or the day after their operation. The rate of finding an incidental tumor was 1.1%, with greater rates in the elderly (2.7% among patients aged ≥65 years). The overall rate of a negative appendectomy (NA) was 3.8%; the negative appendectomy rate was 1.7% for patients with any positive imaging study and 19.4% for patients with no imaging. The 30-day mortality was 0.04%; 30-day rates of any complication and serious complications were 3.0% and 2.2%, respectively. Preoperative imaging, a laparoscopic approach, and excellent clinical outcomes have become the norm for the surgical management of uncomplicated appendicitis. As surgeons contemplate the role of nonoperative therapy for uncomplicated appendicitis, the data presented here should be used to inform the ongoing debate.