Studies on outcomes following appendectomy in liver transplant (LT) recipients have been limited to case series. This study investigates early postoperative outcomes following laparoscopic (lap) vs open appendectomy in this patient population using a nationwide dataset, comparing outcomes at transplant vs non-transplant centers.

METHODS: The Nationwide Inpatient Sample was used to study 595 LT recipients and 790,000 non-transplant recipients who underwent appendectomy (2000-2011). Postoperative complications were defined by ICD-9 code. Complication rates, length of stay (LOS), and hospital cost were compared using hierarchical logistic regression, hierarchical negative binomial regression, and mixed effects log-linear models respectively.

RESULTS: A larger proportion of LT recipients underwent appendectomy at LT centers compared to non-transplant patients (54.2% vs 6.3%). The lap approach was used in 37.7% of LT recipients vs 54.4% of non-transplant patients. After adjustment, the use of laparoscopy was significantly lower at transplant centers (OR 0.17, 95%CI: 0.08-0.33, interaction p-value=0.005). LT recipients had similar complication rates compared to non-transplant patients (OR 0.59, 95% CI: 0.24-1.45) but longer LOS (IRR 1.24, 95%CI: 1.03-1.50) regardless of center type. LT recipients also incurred higher costs at transplant centers compared to non-transplant peers (Ratio 1.37, 95%CI: 1.21-1.55; interaction p-value <0.001). Among LT recipients, surgical approach did not significantly impact complication rates, LOS or hospital costs.

CONCLUSION: LT recipients do not have an increased risk of early postoperative complications, regardless of surgical approach or center type. They are however at greater risk for extended LOS regardless of center type. LT recipients incur higher hospital costs compared to non-transplant patients, particularly at transplant centers.

CITATION INFORMATION: Dagher N, DiBrito S, Olorundare I, Landazabal C, Segev D. Outcomes Following Appendectomy in Liver Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

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