Skip to main content
SpringerLink
Log in

Trend, variability, and outcome of open vs. laparoscopic appendectomy based on a large administrative database

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

An Erratum to this article was published on 13 March 2014

Abstract

The aim of this study was to ascertain the variability and 9-year trends in the use of laparoscopic surgery for appendicitis using data from a large administrative database, to compare the effectiveness and efficiency of laparoscopic (LA) and open appendectomy, and to ascertain whether different choices of surgical approach stem from evidence-based recommendations. This was a retrospective cohort study based on administrative data collected from 2000 to 2008 in the Veneto Region (northeastern Italy). Funnel plots were used to display variability between local health units (LHUs). A total of 38,314 appendectomies were performed from 2000 to 2008 in the Veneto Region, 53% of them in males. The laparoscopic procedure was used more often for females than for males of fertile age. There was a significant rising linear trend in the use of LA, with a higher increment among females. The overall regional standardized appendectomy rate was 82.9/10,000. The mean proportion of LAs (27.3%) ranged from 2.8 to 59.4% at different LHUs, and there was no relationship between the volume of procedures undertaken and the proportion of LAs. The proportion of LAs performed in females of reproductive age also varied considerably, on no apparent evidence-based grounds. The analysis of aggregate clinical data is a powerful tool for supporting regional health management units in efforts to improve the quality of medical care and assess the appropriateness of therapeutic or diagnostic approaches in the light of practical guidelines. Variability in the treatment of a given disease that lacks any evidence-based justification remains an important issue in national health systems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. McBurney C IV (1894) The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Ann Surg 20(1):38–43

    Article  PubMed  CAS  Google Scholar 

  2. Eriksson S, Granström L (1995) Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis. Br J Surg 82:166–169

    Article  PubMed  CAS  Google Scholar 

  3. Semm K (1983) Endoscopic appendectomy. Endoscopy 15(2):59–64

    Article  PubMed  CAS  Google Scholar 

  4. Sauerland S, Jaschinski T, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev (10): CD001546

  5. Nguyen NT, Zainabadi K, Mavandadi S, Paya M, Stevens CM, Root J, Wilson SE (2004) Trends in utilization and outcomes of laparoscopic versus open appendectomy. Am J Surg 188(6):813–820

    Article  PubMed  Google Scholar 

  6. Kim MJ, Fleming FJ, Gunzler DD, Messing S, Salloum RM, Monson JR (2011) Laparoscopic appendectomy is safe and efficacious for the elderly: an analysis using the National Surgical Quality Improvement Project database. Surg Endosc 25(6):1802–1807

    Article  PubMed  Google Scholar 

  7. Bencini L, Bernini M, Martini F, Rossi M, Tommasi C, Miranda E, Sanchez LJ, Naspetti R, Manetti R, Ferrara A, Nesi S, Boffi B, Farsi M, Moretti R (2009) Laparoscopic appendectomy performed by residents and experienced surgeons. JSLS 13(3):391–397

    PubMed  Google Scholar 

  8. Lin YY, Shabbir A, So JB (2010) Laparoscopic appendectomy by residents: evaluating outcomes and learning curve. Surg Endosc 24(1):125–130

    Article  PubMed  Google Scholar 

  9. Rezola E, Villanueva A, Garay J, Suñol M, Arana J, Intxaurrondo MI, Eizaguirre I (2008) Laparoscopic appendectomy after the learning curve. Cir Pediatr 21(3):167–172

    PubMed  CAS  Google Scholar 

  10. Ministero della Salute, Dipartimento della Qualità Direzione Generale della programmazione sanitaria, dei livelli di assistenza e dei principi etici di sistema, Ufficio VI (2008) Rapporto annuale sull’attività di ricovero ospedaliero. Dati SDO. http://www.salute.gov.it/imgs/C_17_pubblicazioni_1253_allegato.pdf. Accessed 15 June 2011

  11. Guller U, Hervey S, Purves H, Muhlbaier LH, Peterson ED, Eubanks S, Pietrobon R (2004) Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Ann Surg 239(1):43–52

    Article  PubMed  Google Scholar 

  12. Blomqvist PG, Andersson RE, Granath F, Lambe MP, Ekbom AR (2001) Mortality after appendectomy in Sweden, 1987–1996. Ann Surg 233:455–460

    Article  PubMed  CAS  Google Scholar 

  13. Bisset AF (1997) Appendicectomy in Scotland: a 20-year epidemiological comparison. J Public Health Med 19:213–218

    Article  PubMed  CAS  Google Scholar 

  14. Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG, Wei HB (2011) Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis. Surg Endosc 25(4):1199–1208

    Article  PubMed  Google Scholar 

  15. Wei HB, Huang JL, Zheng ZH, Wei B, Zheng F, Qiu WS, Guo WP, Chen TF, Wang TB (2010) Laparoscopic versus open appendectomy: a prospective randomized comparison. Surg Endosc 24(2):266–269

    Article  PubMed  Google Scholar 

  16. Nakhamiyayev V, Galldin L, Chiarello M, Lumba A, Gorecki PJ (2010) Laparoscopic appendectomy is the preferred approach for appendicitis: a retrospective review of two practice patterns. Surg Endosc 24(4):859–864

    Article  PubMed  Google Scholar 

  17. Long KH, Bannon MP, Zietlow SP, Helgeson ER, Harmsen WS, Smith CD, Ilstrup DM, Baerga-Varela Y, Sarr MG (2001) Laparoscopic Appendectomy Interest Group. A prospective randomized comparison of laparoscopic appendectomy with open appendectomy: clinical and economic analyses. Surgery 129(4):390–400

    PubMed  CAS  Google Scholar 

  18. Hebebrand D, Troidl H, Spangenberger W, Neugebauer E, Schwalm T, Günther MW (1994) Laparoscopic or classical appendectomy? A prospective randomized study. Chirurg 65:112–120

    PubMed  CAS  Google Scholar 

  19. Mutter D, Vix M, Bui A, Evrard S, Tassetti V, Breton JF, Marescaux J (1996) Laparoscopy not recommended for routine appendectomy in men: results of a prospective randomized study. Surgery 120:71–74

    Article  PubMed  CAS  Google Scholar 

  20. Minné L, Varner D, Burnell A, Ratzer E, Clark J, Haun W (1997) Laparoscopic vs open appendectomy. Prospective randomized study of outcomes. Arch Surg 132:708–711 (discussion 712)

    Article  PubMed  Google Scholar 

  21. Vernon AH, Georgeson KE, Harmon CM (2004) Pediatric laparoscopic appendectomy for acute appendicitis. Surg Endosc 18(1):75–79 (erratum: Surg Endosc 18(3):568)

    Google Scholar 

  22. Grewal H, Sweat J, Vazquez WD (2004) Laparoscopic appendectomy in children can be done as a fast-track or same-day surgery. JSLS 8(2):151–154

    PubMed  Google Scholar 

  23. Billingham MJ, Basterfield SJ (2010) Pediatric surgical technique: laparoscopic or open approach? A systematic review and meta-analysis. Eur J Pediatr Surg 20(2):73–77

    Article  PubMed  CAS  Google Scholar 

  24. Reissfelder C, Mc Cafferty B, von Frankenberg M (2009) Open appendectomy When do we still need it? Chirurg 80(7):602–607

    Article  PubMed  CAS  Google Scholar 

  25. Bensard DD, Hendrickson RJ, Fyffe CJ, Careskey JM, Azizkhan RG (2009) Early discharge following laparoscopic appendectomy in children utilizing an evidence-based clinical pathway. J Laparoendosc Adv Surg Tech A 19(Suppl 1):S81–S86

    Article  PubMed  Google Scholar 

Download references

Disclosures

Alessandra Buja, Domenico Mantoan, Giampietro Callegaro, Mario Saia, Paolo Sandonà, Tatjana Baldovin, or Vincenzo Baldo have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. EuroHealth Net, Veneto Region Health Directorate, Palazzo Molin, San Polo, 2513 - 30125, Venezia (VE), Italy

    Mario Saia & Domenico Mantoan

  2. Department of Environmental Medicine and Public Health, University of Padova, Via Loredan, 18, 35128, Padova, Italy

    Alessandra Buja, Tatjana Baldovin, Paolo Sandonà & Vincenzo Baldo

  3. EuroHealth Net, Local Health Unit N°8, Via Forestuzzo 41, 31011, Asolo, Veneto Region, Italy

    Giampietro Callegaro

Authors
  1. Mario Saia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessandra Buja
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tatjana Baldovin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giampietro Callegaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paolo Sandonà
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Domenico Mantoan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vincenzo Baldo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alessandra Buja.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s00464-014-3492-z.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Saia, M., Buja, A., Baldovin, T. et al. Trend, variability, and outcome of open vs. laparoscopic appendectomy based on a large administrative database. Surg Endosc 26, 2353–2359 (2012). https://doi.org/10.1007/s00464-012-2188-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2188-5

Keywords

Search

Navigation