Trends and outcomes of laparoscopic appendectomy in China: A multicenter, retrospective cohort study

Aim The present study examined the status and trends of laparoscopic appendectomy (LA) in China as a developing country and compared its surgical outcomes with open appendectomy (OA). Patients and Methods A retrospective study was performed on 12586 consecutive patients who underwent appendectomy for acute appendicitis at nine hospitals in China between 2011 and 2013. A multivariate logistic regression model was used to assess independent risk factors associated with the development of postoperative complications. Results The annual proportion of LA increased from 11.5 per cent to 20.8 per cent to 40.7 per cent in the 3-year period. In comparison to OA, LA was associated with a lower postoperative complication rate (7.6 per cent vs 9.5 per cent, P=0.001), a shorter hospital stay (mean: 5.4 days vs 6.5 days, P<0.001) and a lower 30-day readmission rate (2.3 per cent vs 3.1 per cent, P=0.020). Multivariate analysis revealed that LA was independently associated with a decreased postoperative complication rate for all patients [odds ratio (OR): 1.44, P=0.01], for a subgroup of patients with perforated appendicitis (OR: 4.32, P<0.01) and for a subgroup of patients with unperforated appendicitis (OR: 1.50, P=0.01). Conclusions The use of LA has increased rapidly in China in recent years. LA has been found to significantly lower the postoperative complication rate, even in perforated appendicitis. The laparoscopic procedure could be the preferred method for the surgical treatment of acute appendicitis in China in the future.