Unplanned Reoperation And Interventional Radiology Post Appendicectomy: A Meta-Analysis

Abstract

Introduction: Optimizing delivery of care to patients with appendicitis as part of an emergency general surgery care program is important. Appendicitis is one of commonest emergency surgical presentations and has significant potential morbidity and occasional mortality. Meta-analysis of reinterventions following appendicectomy has not been published. This meta-analysis evaluated the prevalence and potential predictors of reoperation and interventional radiological (IR) procedures post appendicectomy. Methods: A PROSPERO-registered (ID CRD42017069040) meta-analysis following PRISMA guidelines using databases PubMed and Scopus for studies between June 2012 to May 2017 was undertaken. Headings included “reoperation”, “return to operation theatre”, “complication”, “appendicectomy”, “outcome”, “abscess drainage”. Articles scoring ≥16 for comparative and ≥10 for non-comparative using MINORS criteria were included. Results: 2810 articles reviewed were reduced to 52 qualifying studies for a final analysis of 319,053 appendicectomies. Overall, 0.9% (range 0.0% to 14.2%) underwent some form of reintervention. The reoperation rate was 0.6% (range 0.0 to 14.2%) and radiologic drainage rate 1.5% (range 0.0% to 11.1%). Reoperations were significantly associated with a laparoscopic approach, earlier grade of appendicitis and not using drains. Laparoscopy conversion to open and the grade of surgeon performing the appendicectomy did not affect reintervention. Conclusion: This meta-analysis identified a small but notable reoperation and IR rate, significantly increased by complexity of appendicitis and open surgery. Strategies promoting for earlier presentation and diagnosis with laparoscopic approaches may improve overall outcomes.