Laparoscopic vs Open Appendectomy in Obese Patients: Outcomes Using the American College of Surgeons National Surgical Quality Improvement Program Database

BACKGROUND: Although open and laparoscopic appendectomies are comparable operations in terms of outcomes, it is unknown whether this is true in the obese patient. Our objective was to compare short-term outcomes in obese patients after laparoscopic vs open appendectomy. STUDY DESIGN: Using the American College of Surgeons National Surgical Quality Improvement Program database (2005 - 2009), 13,330 obese patients (body mass index >= 30) who underwent an appendectomy were identified (78% laparoscopic, 22% open). The association between surgical approach (laparoscopic vs open) and outcomes was first evaluated using multivariable logistic regression. Next, to minimize the influence of treatment selection bias, we created a 1: 1 matched cohort using all 41 of the preoperative covariates in the National Surgical Quality Improvement Program database. Reanalysis was then performed with the unmatched patients excluded. Main outcomes measures included patient morbidity and mortality, operating room return, operative times, and hospital length of stay. RESULTS: Laparoscopic appendectomy was associated with a 57% reduction in overall morbidity in all the obese patients after the multivariable risk-adjusted analysis (odds ratio = 0.43; 95% CI, 0.36 - 0.52; p < 0.0001), and a 53% reduction in risk in the matched cohort analysis (odds ratio = 0.47; 95% CI, 0.32 - 0.65; p < 0.0001). Mortality rates were the same. In the matched cohort, length of stay was 1.2 days shorter for obese patients undergoing laparoscopic appendectomy compared with open appendectomy (mean difference 1.2 days; 95% CI, 0.98 - 1.42). CONCLUSIONS: In obese patients, laparoscopic appendectomy had superior clinical outcomes compared with open appendectomy after accounting for preoperative risk factors. (J Am Coll Surg 2012; 215: 88-100. (C) 2012 by the American College of Surgeons)