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.

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    ABSTRACT: Objective To determine if use of a wound-protection system in open appendectomy decreases the rate of wound infection.Design A randomized prospective trial.Setting A community hospital.Patients One hundred nine patients undergoing open appendectomy.Intervention Randomly assigned conventional retraction or retraction with the wound-protection system. Patients were blinded to the study arm in which they were enrolled. All patients were given standardized preoperative antibiotics. Demographics including age, sex, body mass index, history of diabetes, and tobacco use were recorded. The severity of appendicitis as determined by the attending surgeon at the time of operation was also noted.Main Outcome Measures Incidence of wound infection at 21 days postoperatively.Results Of the 48 patients enrolled in the traditional retraction arm, there were 7 (14.6%) documented wound infections. Of the 61 patients enrolled in the wound-protection device arm, there was 1 (1.6%) wound infection. The severity of appendicitis between the 2 groups was matched. The decrease in incidence of wound infection observed with the wound-protection system was significant (P = .02).Conclusion Use of a wound-protection system reduces the incidence of surgical wound infection in open appendectomy.Trial Registration Identifier: NCT00323453
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