Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy - results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study
Authors: Walędziak Maciej , Lasek Anna , Wysocki Michał , Su Michael , Bobowicz Maciej , Myśliwiec Piotr , Astapczyk Kamil , Burdzel Mateusz , Chruściel Karolina , Cygan Rafał , Czubek Wojciech , Dowgiałło-Wnukiewicz Natalia , Droś Jakub , Franczak Paula , Hołówko Wacław , Kacprzyk Artur , Karcz Wojciech Konrad , Kenig Jakub , Konrad Paweł , Kopiejć Arkadiusz , Kot Adam , Krakowska Karolina , Kukla Maciej , Leszko Agnieszka , Łozowski Leszek , Major Piotr , Makarewicz Wojciech , Malinowska-Torbicz Paulina , Matyja Maciej , Michalik Maciej , Niekurzak Adam , Nowiński Damian , Ostaszewski Radomir , Pabis Małgorzata , Polańska-Płachta Małgorzata , Rubinkiewicz Mateusz , Stefura Tomasz , Stępień Anna , Szabat Paweł , Śmiechowski Rafał , Tomaszewski Sebastian , von Ehrlich-Treuenstätt Viktor , Wasilczuk Maciej , Wierdak Mateusz , Wojdyła Anna , Wroński Jan Wojciech , Zwolakiewicz Leszek , Pędziwiatr Michał 
Published: October 2019

Laparoscopic appendectomy (LA) for treatment of acute appendicitis has gained acceptance with its considerable benefits over open appendectomy. LA, however, can involve some adverse outcomes: morbidity, prolonged length of hospital stay (LOS) and hospital readmission. Identification of predictive factors may help to identify and tailor treatment for patients with higher risk of these adverse events. Our aim was to identify risk factors for serious morbidity, prolonged LOS and hospital readmission after LA. A database compiled information of patients admitted for acute appendicitis from eighteen Polish and German surgical centers. It included factors related to the patient characteristics, peri- and postoperative period. Univariate and multivariate logistic regression models were used to identify risk factors for serious perioperative complications, prolonged LOS, and hospital readmissions in acute appendicitis cases. 4618 laparoscopic appendectomy patients were included. First, although several risk factors for serious perioperative complications (C-D III-V) were found in the univariate analysis, in the multivariate model only the presence of intraoperative adverse events (OR 4.09, 95% CI 1.32–12.65, p = 0.014) and complicated appendicitis (OR 3.63, 95% CI 1.74–7.61, p = 0.001) was statistically significant. Second, prolonged LOS was associated with the presence of complicated appendicitis (OR 2.8, 95% CI: 1.53–5.12, p = 0.001), postoperative morbidity (OR 5.01, 95% CI: 2.33–10.75, p < 0.001), conversions (OR 6.48, 95% CI: 3.48–12.08, p < 0.001) and reinterventions after primary procedure (OR 8.79, 95% CI: 3.2–24.14, p < 0.001) in the multivariate model. Third, although several risk factors for hospital readmissions were found in univariate analysis, in the multivariate model only the presence of postoperative complications (OR 10.33, 95% CI: 4.27–25.00), reintervention after primary procedure (OR 5.62, 95% CI: 2.17–14.54), and LA performed by resident (OR 1.96, 95% CI: 1.03–3.70) remained significant. Laparoscopic appendectomy is a safe procedure associated with low rates of complications, prolonged LOS, and readmissions. Risk factors for these adverse events include complicated appendicitis, postoperative morbidity, conversion, and re-intervention after the primary procedure. Any occurrence of these factors during treatment should alert the healthcare team to identify the patients that require more customized treatment to minimize the risk for adverse outcomes.