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Bowel Obstruction Following Appendectomy: What is the True Incidence?

Bowel Obstruction Following Appendectomy: What is the True Incidence?. Leung, T.W. MD; Dixon, Elijah MD, BSc, MSc; Gill, Manpreet BSc; Brett D. BSc; Moulton, Kyle M. BHSc; Kaplan, Gilaad G. MD, MPh; MacLean, Anthony R. MD, FRCS(C), FACS Annals of Surgery: Volume 250(1), July 2009, pp51 -53.

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Bowel Obstruction Following Appendectomy: What is the True Incidence?

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  1. Bowel Obstruction Following Appendectomy: What is the True Incidence? Leung, T.W. MD; Dixon, Elijah MD, BSc, MSc; Gill, Manpreet BSc; Brett D. BSc; Moulton, Kyle M. BHSc; Kaplan, Gilaad G. MD, MPh; MacLean, Anthony R. MD, FRCS(C), FACS Annals of Surgery: Volume 250(1), July 2009, pp51 -53

  2. Objective • Post – appendectomy SBO in adult population • SBO rate b/w open and lap appendectomies • Retrospective study • Administrative discharge database (QSH) • April 1, 1999 and March 31, 2002 • ICD – 9 Codes • Cohort of 2598 patients • 2332 met inclusion criteria • 1777 charts reviewed • Further Admissions for BO • ICD–9 prior to march 2002 • ICD–10-CA after march 2002 • 5 year follow up • Exclusions • No residency data over 5yr follow up • Appendectomies from unrelated procedures (91) • None Available charts (555) • Analysis • Logistic regression: Odd ratio for potential risk factors for developing SBO • Univariate screening to determine covariates to include (P < = 0.20) • Variates with P < = 0.10 were retained • Two sided P value of less than or equal to 0.05 was considered significant • Stratification of result as follows

  3. Result • TABLE 1. Patient Demographics, Surgical Approach, and Pathology • N Percent (%) • Male 894 50.3 • Female 883 49.7 • Previous abdominal surgery 291 16.4 • Immunosuppression 58 3.3 • Surgical approach • RLQ* 969 54.5 • Midline 220 12.4 • Laparoscopic 588 33.1 • Operative description of appendix • Normal 253 14.6 • Suppurative 1328 76.8 • Perforated 138 8.0 • Other† 11 0.6 • *RLQ indicates right lower quadrant. • †Other: cancer, fibrosis. • TABLE 2. Risk Factors for SBO • Risk Factor Odds Ratio 95% C.interval • Midline laparotomy 5.4 2.8–10.4 • Chronic append, cancer* 7.4 2.7–20.3 • Normal appendix* 3.8 1.7–8.6 • Perforated appendicitis* 3.1 1.5–6.6 • *Based on operative findings.

  4. Figures • Figure 1. Rates of SBO by surgical approach P < 0.0001 • Figure 2. Rates of SBO by operative description, P = 0.0015. *Other = Ca, Fibroid

  5. Conclusion • Overall rate for SBO was 2.8% (0.16 to 10.7%) • 0.0069 cases per person per year. • Greatest risk factors • Midline incision • Normal Appendix • Perforated Appendix • Non appendicitis pathology • Non statistically significant difference in SBO rates following lap appendectomy compared with open approaches.

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