Contemporary National Inpatient Trends in appendectomy utilization and operative approach in the United States,...

Contemporary national data on inpatient appendectomy practice remain limited. We evaluated recent trends in appendectomy utilization and operative approach among patients hospitalized with appendicitis and examined patient- and hospital-level factors associated with operative management and inpatient outcomes.

We performed a retrospective cross-sectional study of the National Inpatient Sample from 2016 to 2022. Hospitalized patients with appendectomy procedures were identified using ICD-10 codes. Operative approach was categorized as open, laparoscopic, or robotic. Weighted analyses and multivariable regression evaluated utilization, approach, length of stay, and adverse discharge.

Among 1,035,444 appendicitis hospitalizations, appendectomy utilization declined from 88.8% in 2016 to 82.2% in 2022 (p < 0.001). Among 889,289 appendectomy cases, laparoscopic appendectomy was performed in 90.2% overall and increased to 92.3% by 2022, while open appendectomy declined from 12.4% to 5.9%. Robotic appendectomy increased from 80 to 1900 during study period, (OR 47.02, 95% CI 23.72-93.22). Hispanic patients had slightly higher odds of appendectomy (OR 1.02, 95% CI 1.02-1.03), whereas Black patients (OR 0.94, 95% CI 0.93-0.95) and patients aged ≥65 years (OR 0.85, 95% CI 0.83-0.86) had lower odds. Rural hospitals had lower odds of laparoscopic (OR 0.92, 95% CI 0.91-0.92) and robotic (OR 0.03, 95% CI 0.02-0.03) approaches. Black race and ECI ≥5 were associated with longer length of stay, while older age, Black race, Medicare insurance, and ECI ≥5 were associated with adverse discharge.

Appendectomy utilization declined while laparoscopy remained dominant, open surgery decreased, and robotic use increased but remained uncommon. These findings provide a national descriptive framework for future clinically granular studies of appendicitis management.