Factors Associated With Small Bowel Obstruction Following Appendectomy: A Population-Based Study

Area of Science:

• Gastroenterology
• Surgical Complications
• Epidemiology

Background:

• Postoperative small bowel obstruction (SBO) is a frequent complication following appendectomy.
• Identifying risk factors for SBO is crucial for improving patient outcomes.

Purpose of the Study:

• To assess risk factors associated with SBO after appendectomy.
• To compare the risk of SBO between open appendectomy (OA) and laparoscopic appendectomy (LA).

Main Methods:

• Retrospective cohort study using Taiwan National Health Insurance Research Database (2006-2008).
• Propensity score matching was used to compare OA and LA cohorts (11,289 patients each).
• Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for SBO risk.

Main Results:

• Open appendectomy was associated with a significantly higher risk of adhesive SBO (adjusted HR: 1.7, 95% CI: 1.11-2.63) compared to LA.
• Female sex, complicated appendicitis, higher Charlson Comorbidity Index (CCI) scores, and treatment in district hospitals were identified as risk factors for SBO.
• Female sex (adjusted HR: 1.79), CCI ≥ 1 (adjusted HR: 3.16), CCI ≥ 2 (adjusted HR: 4.03), and complicated appendicitis (adjusted HR: 1.68) increased SBO risk.

Conclusions:

• Female sex, complicated appendicitis, comorbidities, and treatment in district hospitals are associated with increased SBO risk post-appendectomy.
• Laparoscopic appendectomy is associated with a lower risk of SBO compared to open appendectomy.
• These findings support the use of laparoscopic surgery to minimize SBO risk after appendectomy.