Trend, variability, and outcome of open vs. laparoscopic appendectomy based on a large administrative database
- 21 February 2012
- journal article
- research article
- Published by Springer Nature in Surgical Endoscopy
- Vol. 26 (8), 2353-2359
- https://doi.org/10.1007/s00464-012-2188-5
Abstract
The aim of this study was to ascertain the variability and 9-year trends in the use of laparoscopic surgery for appendicitis using data from a large administrative database, to compare the effectiveness and efficiency of laparoscopic (LA) and open appendectomy, and to ascertain whether different choices of surgical approach stem from evidence-based recommendations. This was a retrospective cohort study based on administrative data collected from 2000 to 2008 in the Veneto Region (northeastern Italy). Funnel plots were used to display variability between local health units (LHUs). A total of 38,314 appendectomies were performed from 2000 to 2008 in the Veneto Region, 53% of them in males. The laparoscopic procedure was used more often for females than for males of fertile age. There was a significant rising linear trend in the use of LA, with a higher increment among females. The overall regional standardized appendectomy rate was 82.9/10,000. The mean proportion of LAs (27.3%) ranged from 2.8 to 59.4% at different LHUs, and there was no relationship between the volume of procedures undertaken and the proportion of LAs. The proportion of LAs performed in females of reproductive age also varied considerably, on no apparent evidence-based grounds. The analysis of aggregate clinical data is a powerful tool for supporting regional health management units in efforts to improve the quality of medical care and assess the appropriateness of therapeutic or diagnostic approaches in the light of practical guidelines. Variability in the treatment of a given disease that lacks any evidence-based justification remains an important issue in national health systemsKeywords
This publication has 25 references indexed in Scilit:
- Laparoscopic appendectomy is safe and efficacious for the elderly: an analysis using the National Surgical Quality Improvement Project databaseSurgical Endoscopy, 2011
- Laparoscopic versus open surgery for suspected appendicitisCochrane Database of Systematic Reviews, 2010
- Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysisSurgical Endoscopy, 2010
- Laparoscopic appendectomy by residents: evaluating outcomes and learning curveSurgical Endoscopy, 2009
- Laparoscopic appendectomy is the preferred approach for appendicitis: a retrospective review of two practice patternsSurgical Endoscopy, 2009
- Pediatric laparoscopic appendectomy for acute appendicitisSurgical Endoscopy, 2004
- Mortality After Appendectomy in Sweden, 1987–1996Annals of Surgery, 2001
- A prospective randomized comparison of laparoscopic appendectomy with open appendectomy: Clinical and economic analysesSurgery, 2001
- Laparoscopy not recommended for routine appendectomy in men: Results of a prospective randomized studySurgery, 1996
- Endoscopic AppendectomyEndoscopy, 1983