The Morbidity and Mortality of Laparoscopic Appendectomy in Patients with Cirrhosis

Abstract

Introduction:The perioperative mortality is significantly higher in patients with cirrhosis undergoing certain surgical procedures. In this study, we examined the inpatient perioperative mortality and morbidities in cirrhotic people who underwent laparoscopic appendectomy.Methods:We performed a retrospective analysis using the National Inpatient Sample database for 2010. Inclusion criteria were all race and sex who are 18 years or older. Those who have laparoscopic appendectomy and have a history of liver cirrhosis were assigned to case group. An equal random number of appendectomy-related admissions and those who have no history of liver cirrhosis were selected and placed in the control group. A binary logistic regression statistical test was used to examine the odds ratio for the mortality difference and postoperative complication including pneumonia, urinary tract infection (UTI), surgical site infection, postoperative bleeding. IBM SPSS statistics was used to execute the analysis. A confidence interval of 95% and P value less than .05 were determined to define the statistical significance.Result:A total of 754 appendectomy-related admissions were identified—376 appendectomy-related admissions and history of cirrhosis and 378 admissions with appendectomy and no history of cirrhosis. Control group was not found to be statistically different from the case group when it comes to age, race, and sex. Of 754, 520 were white (73.5%), 334 (44.3%) were men. The mean age was 43.75 years for the case group and 46.68 years for the control group. Comparing cirrhotic with noncirrhotic group, the mean length of stay was 1.1 vs 1.52 days, inpatient mortality was 2 (0.5%) vs 1 (0.3%) (P = .56), pneumonia 8 (2.1%) vs 3 (0.8%) (P = .142), surgical site infection 3 (0.8%) vs 2 (0.5%) (P = .652), UTI 18 (4.8%) vs 12 (3.2%) (P = .26), and postoperative bleeding 3 (0.8%) vs 2 (0.5%) (P = .65).Conclusions:Appendectomy-related morbidity and mortality in cirrhotic patients are not different from noncirrhotic patients.

Management and Outcomes of Acute Appendicitis in the Presence of Cirrhosis: A Nationwide Analysis

“…2 However, in our study, because of the longer HLOS in DC patients treated by OA, the total cost of LA was markedly lower. Of interest, our HLOS was much shorter than Tsugawa et al 2 but much longer than reported by Al-Azzawi et al, 5 which cites 1.1 and 1.52 days for NC and cirrhotics, respectively, from the 2010 NIS data. We are unaware of what could have caused the significantly longer stays nationwide a few years later.…”

“…The best management option for AA in cirrhotic patients is controversial, and it has not yet been established by high-powered prospective research. Compared with the available publications, 2,3,5 this study analyzed the largest number of cirrhotics with AA (n 4 438) and, for the first time, stratified patients based on the severity of cirrhosis. Not surprisingly, cirrhotics fared worse in all primary outcome measures compared with NC.…”

“…2,4 To date, there has been a paucity of studies evaluating the impact of cirrhosis on the outcomes of acute appendicitis (AA). 2,3,5 Laparoscopic appendectomy (LA) is generally accepted as the firstline treatment for AA, but open appendectomies (OA) are still performed and NOM has recently re-emerged as a potential viable treatment option. 6 We aimed to investigate the outcomes of different treatment options for AA in cirrhotic patients.…”

Mortality Following Appendicectomy in Patients with Liver Cirrhosis: A Systematic Review and Meta‐Analysis

“…The studies span an 18-year period from 2001 to 2019. Two studies were undertaken in the USA [ 17 , 29 ], one in Denmark [ 16 ], and one in Japan [ 28 ]. Three were nationwide database studies [ 16 , 17 , 29 ], and one, a retrospective observational study undertaken at two centres [ 28 ] (Table 1 ).…”

“…However, most data regarding appendicitis derives from retrospective cohort studies, with conflicting rates of complications and mortality. For example, a Danish nationwide database study found an eight-fold increase in mortality in patients with cirrhosis [ 16 ] whereas a USA nationwide database study found no difference [ 17 ]. Consequently, decision-making in daily practice remains unclear.…”