Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

Abstract

Background Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. While many studies report readmission, a meta‐analysis of readmission post‐appendectomy has not been published. This meta‐analysis was undertaken to determine rates and predictors of hospital readmission following appendectomy and to potentially provide a metric benchmark. Methods An ethically approved PROSPERO‐registered (ID CRD42017069040) meta‐analysis following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, using databases PubMed and Scopus, was undertaken for studies published between January 2012 and June 2017. Articles relating to outcomes and readmissions after appendectomy were identified. Those scoring >15 for comparative studies and >10 for non‐comparative studies, using Methodological Index for Non‐Randomized Studies criteria were included in the final analysis. The odds ratios (OR) using random‐effects, Mantel–Haenszel method with 95% confidence intervals (CI), were computed for each risk factor with RevMan5. Results A total of 1757 articles reviewed were reduced to 45 qualifying studies for a final analysis of 836 921 appendectomies. 4.3% (range 0.0–14.4%) of patients were readmitted within 30 days. Significant preoperative patient factors for increased readmission were diabetes mellitus (OR 1.93, CI 1.63–2.28, P < 0.00001), complicated appendicitis (OR 3.6, CI 2.43–5.34, P < 0.00001) and open surgical technique (OR 1.39, CI 1.08–1.79, P < 0.00001). Increased readmission was not associated with gender, obesity or paediatric versus general surgeons or centres. Conclusion This meta‐analysis identified that readmission is not uncommon post‐appendectomy, occurring in one in 25 cases. The mean readmission rate of 4.3% may act as a quality benchmark for improving emergency surgical care. Targeting high‐risk groups with diabetes or complicated appendicitis and increasing use of laparoscopic technique may help reduce readmission rates.

Appendicitis in Far North Queensland: a new take on an old story

“…In our series, about 20% of people required a longer hospital stay, consistent with other published studies 17,18 . Our study's reported indicators of complicated appendicitis, such as conversion to open surgery, hospital readmission and mortality rates are also consistent 4,19–21 …”

“…17,18 Our study's reported indicators of complicated appendicitis, such as conversion to open surgery, hospital readmission and mortality rates are also consistent . 4,[19][20][21] Indigenous patients tended to stay longer than their non-Indigenous counterparts. Very Remote patients (ARIA 5) had the longest LOS, median 2.6 days for Indigenous and 2.1 days for non-Indigenous patients.…”

Complicated appendicitis increases the hospital length of stay

“…Prior research has thoroughly investigated the 30-day readmission rates. CA affects the readmission with a lower rate in laparoscopic compared to open technique [ 33 , 34 ]. A recent meta-analysis substantiates that factors such as CA, diabetes mellitus, and open technique influence unexpected readmission within 30 days [ 35 ].…”

Acute appendicitis–advances and controversies

“…Laparoscopic appendectomy is associated with reduced 30-d readmission. In a meta-analysis including 45 studies and 836921 appendectomies, Bailey et al [ 103 ] has reported a 4.3% (range 0.0-14.4%) 30-d readmission rate. Diabetes mellitus, complicated appendicitis, and open appendectomy predicted 30-d readmission[ 103 ], and thus laparoscopic appendectomy may be superior if available and accessible.…”

“…In a meta-analysis including 45 studies and 836921 appendectomies, Bailey et al [ 103 ] has reported a 4.3% (range 0.0-14.4%) 30-d readmission rate. Diabetes mellitus, complicated appendicitis, and open appendectomy predicted 30-d readmission[ 103 ], and thus laparoscopic appendectomy may be superior if available and accessible. Laparoscopic appendectomy is also notably more cost-effective compared to not only open surgery but NOM as well.…”