Demographic and socioeconomic trends in the use of laparoscopic appendectomy from 1997 to 2003

Department of Surgery, Oregon Health & Sciences University, Portland, OR, USA.
American journal of surgery (Impact Factor: 2.29). 05/2008; 195(5):580-3; discussion 583-4. DOI: 10.1016/j.amjsurg.2007.12.031
Source: PubMed


Because there is conflicting evidence regarding the benefits of laparoscopic appendectomy, we hypothesized that there would be measurable differences in its use among various socioeconomic groups and geographic areas.
The Nationwide Inpatient Sample was queried for appendectomies performed between the years of 1997 and 2003. Rates of laparoscopic appendectomy were compared among hospital subtypes and demographic groups.
The percentage of appendectomies performed laparoscopically has increased from 19.1% in 1997 to 37.9% in 2003. Only 11.8% of cases of complicated appendicitis were treated laparoscopically in 1997, compared with 23.5% in 2003. Nonwhite patients and those from low-income areas continue to be less likely to undergo laparoscopic appendectomy (P < .001).
Our analysis indicates that despite expanding use of laparoscopic appendectomy nationwide, patients who live in zip codes areas with a preponderance of minorities or low-income earners are more likely to have open appendectomy.

4 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: ChemInform is a weekly Abstracting Service, delivering concise information at a glance that was extracted from about 200 leading journals. To access a ChemInform Abstract, please click on HTML or PDF.
    ChemInform 01/2006; 54(3):49-72. DOI:10.1016/S0065-3055(05)54002-4
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study is to compare data of patients submitted to appendectomy for acute appendicitis at a public hospital and at a private hospital. A total of 200 medical records of patients submitted to appendectomy for acute appendicitis at a public hospital (n=100) and at a private hospital (n=100), was reviewed retrospectively. Mean age and gender distribution were similar for patients of both hospitals. More patients had been previously evaluated by other physicians in the group of the public hospital (n=85) than of the private hospital (n=13) (p< 0.0001). Ultrasonography was performed more frequently on patients of the public hospital (n=56) than of the private hospital (n=30) (p=0.0002). Length of hospital stay was longer at the public hospital (3.5 ± 2.8 days) than at the private hospital (2.5 ± 1.7 days) (p=0.0024). Postoperative complications were more frequent at the public hospital (n=36) than at the private hospital (n=20) (p<0.0117). Time to resume routine activities was longer for the public hospital (33.2 ± 8.3 days) than for the private hospital (16.4 ± 5.2 days) (p<0.0001). Multivariate logistic-regression analysis showed that the estimated probability of complicated appendicitis increased with the time interval between onset of symptoms and appendectomy (p<0.001). Independent risk factor associated with complicated appendicitis was the time interval between onset of symptoms and appendectomy (odds ratio 41.65, 95% CI {confidence interval} 2.90-597.49, p<0.0001) at the public hospital. There was no independent risk factor associated with complicated appendicitis at the private hospital. There are important differences between public and private hospitals in the diagnosis and outcomes of patients with acute appendicitis submitted to appendectomy.
    Revista da Associação Médica Brasileira 12/2009; 56(5):522-7. DOI:10.1590/S0104-42302010000500011 · 0.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Acute appendicitis is the most common acute abdomen in general surgery. Show-Chwan Memorial Hospital began an AITS/IRCAD laparoscopic training program in late May 2008. In this retrospective analysis, we surveyed the impact of the AITS training program on surgeons' preference for open appendectomy (OA) versus laparoscopic appendectomy (LA). From January 1, 2004 to July 31, 2009, patients diagnosed with acute appendicitis in Changhua Show-Chwan Memorial Hospital and Chang-Bing Show-Chwan Memorial Hospital were retrospectively analyzed. Demographic data, laboratory examinations, surgical methods, hospital stay, and complication rate data were collected and analyzed. The LA rate and effect of surgeons' preference before and after AITS were compared. In all, 1,267 patients (58.2% male and 41.8% female; mean age, 36.6 years) were diagnosed with acute appendicitis during this period. Among them, 78.9% of patients had uncomplicated and 21.1% complicated appendicitis; 784 patients (61.9%) underwent OA, and 465 (36.7%) received LA. In 2004, only 8.1% of patients underwent LA, but the number increased rapidly to 90.4% in 2009 (P < 0.001). The average LA rate before AITS was 21%; however, after AITS, the LA rate increased to 84.6% (P < 0.001). The LA rate increased for all surgeons completing the training course, ranging from 16 to 83%. The overall appendectomy complication rate was 8.4%, with no significant difference between OA (9.7%) and LA (6.5%; P = 0.174). Hospital stay was shorter in the LA group (4.05 ± 1.9 days) compared with the OA group (4.55 ± 3.6; P = 0.006). Attending the laparoscopic training course significantly increased surgeons' preference for LA.
    Surgical Endoscopy 02/2010; 24(9):2210-5. DOI:10.1007/s00464-010-0930-4 · 3.26 Impact Factor
Show more