Traditional open appendectomy for obese patients involves longer hospital stay and higher rates of infectious complications when compared to minimally invasive operations, according to a new study.

Researchers at the University of Southern California (USC; Los Angeles, USA) conducted a retrospective study involving 13,330 obese patients who underwent an appendectomy; of these patients, 78% underwent a laparoscopic procedure and 22% an open one. The association between surgical approach and outcomes was first evaluated using multivariable logistic regression. Next, to minimize the influence of treatment selection bias, the researchers created a matched cohort, and reanalysis was performed with the unmatched patients excluded. The main outcomes measures included patient morbidity and mortality, operating room return, operative times, and hospital length of stay.

The results showed that laparoscopic appendectomy was associated with a 57% reduction in overall morbidity in all the obese patients after the multivariable risk-adjusted analysis, and a 53% reduction in risk in the matched cohort analysis; mortality rates were the same. In the matched cohort, length of stay was 1.2 days shorter for obese patients undergoing laparoscopic appendectomy compared with open appendectomy. Also, the more patients weighed, the worse their outcomes were with open procedures. In contrast, all the patients who underwent the laparoscopic procedure had similar outcomes, regardless of how obese they were. The study was published in the July 2012 issue of the Journal of American College of Surgeons.

“We’ve shown a shorter length of stay; there’s the cost savings right there,” said lead author associate professor of surgery Rodney Mason, MD, MB BCh. “Also if you can prevent a patient’s wound infection, which stops him or her from having to come see the doctor four times after a procedure, reducing that complication will reduce costs. And if someone doesn’t get pneumonia after an operation, that result will be cost-effective as well.”

Laparoscopic appendectomy is safe and effective in obese patients, and may be the preferred approach since it may convey some advantages over the open approach in access to the appendix, visualization, and decrease in wound complications. In the morbidly obese, however, longer trocars and instruments may be needed.

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