K. N. Marley1, A. M. Fecher1, B. L. Zarzaur1, G. A. Gomez1 1Indiana University School Of Medicine,Department Of Surgery,Indianapolis, IN, USA
Introduction: Laparoscopic appendectomy (LA) is well accepted as a standard treatment for patients with acute appendicitis. However, the types of complications and the patients likely to suffer them are not well characterized. The purpose of this study was to characterize the types of complications that occur after LA and to determine factors for complication occurrence.
Methods: A retrospective review was performed to include patients 15 years and older undergoing a LA (CPT code 44970) between January 1, 2009 and April 1, 2014 at a single institution. Demographic data, imaging, pathology, operative reports, length of stay, complications, and relevant history were obtained. Bivariate and multivariable analyses were used to determine risk factors for complications.
Results: 625 patients met inclusion criteria. Complications occurred in 14.6% (n=91) of patients. The 3 most common complications were organ space infections (n=45, 7.2%), superficial surgical site infection (n=23, 3.7%) and ileus (n=15, 2.4%). After bivariate and multivariable analysis, age (45-54yrs vs 15-24yrs – OR 4.14 95%CI 1.83, 9.37), perforated appendix (OR 6.85, 95% CI 3.99, 11.80), and pain prior to surgery (5-7 days vs ≤1 day OR 4.37 95%CI 1.46, 13.14) were associated with complications. Of all LA only one procedure related complication was noted (0.2%) due to a trocar placement injury, but no further complications occurred.
Conclusion: Despite being considered minimally invasive and perceived as safe, LA is associated with complications in nearly 15% of patients undergoing the procedure. Patients who are of middle age, with history of prolonged pain and perforation are at increased risk of suffering complications. Earlier recognition of the signs and symptoms of acute appendicitis in this atypical age range could result in fewer complications overall for LA. Future research should focus on possible areas of intervention in this vulnerable patient population.
