– The first Dutch Snapshot study –
The preferred approach of performing an appendectomy (open or laparoscopic) remains a debate because of conflicting evidence of outcome parameters. Surgical site infections (SSIs) may occur more often after open surgery, but intra-abdominal abscess formation is more frequent after laparoscopy. The clinical importance of these observations remains unclear.
1) To assess the variation in practice and outcomes in the treatment of acute appendicitis, with emphasis on infectious complications after open and laparoscopic appendectomy;
2) To assess the clinical implications of these complications.
This was a prospective, observational audit in 62 academic and general community hospitals in the Netherlands that provide acute general surgical care. Patients were identified on a daily basis; preoperative and intraoperative data were processed after surgery, and the postoperative outcome at the end of follow-up (30 days after surgery).
All consecutive patients (adults and children) who had surgery primarily for suspected acute appendicitis in June and July 2014. Patients treated conservatively, or surgically after failed initial conservative treatment, were not included, and neither were those who had an elective appendectomy or incidental appendectomy.
In total, 1975 patients were included in the 2-month study period. For the main analysis, only data of adult patients that underwent surgery for acute appendicitis (n=1378) were used. Laparoscopy was used in 79.5% of patients, with a conversion rate of 3.4%. Superficial SSIs were less common in the laparoscopic group (OR 0.25 95% CI 0.14-0.44, P<0.001). No significant differences in intra-abdominal abscess formation after laparoscopic or open surgery were found (OR 1.71, 95% CI 0.80-3.63, P-0.166).
After the first publication in January 2016, publications on antibiotic duration for complicated appendicitis, type of appendicular stump closure and current clinical practice in children with acute appendicitis followed. Also, a comparison with a prospective snapshot audit performed in the UK was performed to discuss the role of imaging in the diagnostic work-up of patients who are suspected of acute appendicitis.