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A Population-Based Cohort Study of Emergency Appendectomy Performed in England and New York State

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Abstract

Background

To compare selected outcomes (30-day reoperation and total length of hospital stay) following emergency appendectomy between populations from New York State and England.

Methods

This retrospective cohort study used demographic and in-hospital outcome data from Hospital Episode Statistics (HES) and the New York Statewide Planning and Research Cooperative System (SPARCS) administrative databases for all patients aged 18+ years undergoing appendectomy between April 2009 and March 2014. Univariate and adjusted multivariable logistic regression were used to test significant factors. A one-to-one propensity score matched dataset was created to compare odd ratios (OR) of reoperations between the two populations.

Results

A total of 188,418 patient records, 121,428 (64.4%) from England and 66,990 (35.6%) from NYS, were extracted. Appendectomy was completed laparoscopically in 77.7% of patients in New York State compared to 53.6% in England (P < 0.001). The median lengths of hospital stay for patients undergoing appendectomy were 3 (interquartile range, IQR 2–4) days versus 2 (IQR 1–3) days (P < 0.001) in England and New York State, respectively. All 30-day reoperation rates were higher in England compared to New York State (1.2 vs. 0.6%, P < 0.001), representing nearly a twofold higher risk of 30-day reoperation (OR 1.88, 95% CI 1.64–2.14, P < 0.001). As the proportion of appendectomy completed laparoscopically increased, there was a reduction in the reoperation rate in England (correlation coefficient −0.170, P = 0.036).

Conclusions

Reoperations and total length of hospital stay is significantly higher following appendectomy in England compared to New York State. Increasing the numbers of appendectomy completed laparoscopically may decrease length of stay and reoperations.

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Authors and Affiliations

  1. Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK

    Waleed Al-Khyatt, Benjamin H. L. Tan & Ravinder S. Vohra

  2. Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Yardley Court, 11-13 Frederick Road, Edgbaston, Birmingham, B15 1JD, UK

    Jemma Mytton & Felicity Evison

  3. Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14610, USA

    Christopher T. Aquina & Fergal J. Fleming

  4. Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy

    Sandro Pasquali

  5. Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK

    Ewen A. Griffiths

Authors
  1. Waleed Al-Khyatt
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  2. Jemma Mytton
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  3. Benjamin H. L. Tan
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  4. Christopher T. Aquina
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Correspondence to Ravinder S. Vohra.

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Al-Khyatt, W., Mytton, J., Tan, B.H.L. et al. A Population-Based Cohort Study of Emergency Appendectomy Performed in England and New York State. World J Surg 41, 1975–1984 (2017). https://doi.org/10.1007/s00268-017-3981-z

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  • DOI: https://doi.org/10.1007/s00268-017-3981-z

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