INCIDENTAL APPENDECTOMIES AT THE TIME OF GYNECOLOGIC PROCEDURES: A CASE-CONTROL STUDY.

E. Salom, MD, D Schey, MS, , O Gomez-Marin, PhD, L Mendez, MD, N Lambrou, MD, Z Almeida, MD, M Penalver, MD.

Division of Gynecologic Oncology, University of Miami

   Study Objective: This study was done to evaluate the complication rates of incidental appendectomies in women undergoing benign gynecologic procedures

   Method: A case-controlled study was performed on patients who underwent incidental appendectomies at the University of Miami/ Jackson Memorial Hospital between June 1995 and January 2001. The patient population were divided into two groups: (1) patients who underwent an appendectomy at the time of a abdominal hysterectomy ( Appy group) and 2) and patients who underwent an abdominal hysterectomy without an appendectomy ( TAH group). Information was gathered from hospital and clinic records, and a gynecologic oncology database. Data was abstracted with regards to age, BMI, hypertension(HTN), diabetes mellitus(DM), days NPO, hospital days (HD), and postoperative complications ( cellulitus, fever, ileus, pneumonia, thromboembolic disease). Data was analyzed using two-sample T test and a Chi-squared test followed by the Wilcoxon Rank sum test.

   Results: A total of 200 patients were identified: 100 patients in the Appy group and 100 in the TAH group. Additional procedures at the time of abdominal hysterectomy for each group included: bilateral salpingoopherectomy (69 vs 62), unilateral oophorectomy (19 vs 19), lysis of adhesions (10 vs 8), hypogastric artery ligation (37 vs 4), and others (18 vs 12), Appy vs. TAH group, respectively. The Appy group was found to be younger (mean age: 44 vs. 48, p=0.02) and have a lower BMI (26 vs 30, p=0.0009)) when compared with the TAH group. No difference was found with respect to hypertension, diabetes or the use of preoperative antibiotics. No significant difference was noted in the following postoperative complications: fever (40 vs 27), cellulitus(1 vs. 2), wound collection (4 vs. 6), wound dehiscence (1 vs. 5), Wound abscess (7 vs. 6), ileus (3 vs. 2), urinary tract infection (4 vs. 10) in the Appy group vs TAH group, respectively. A significant increase in the lengt!
h of hospital days was found in the Appy group over the TAH group (p=0.034, 95% CI= 0.36-0.78). When the patients who were electively fed on the second postoperative day were excluded, there was no statistically significant difference in the length of hospital stay.

   Conclusion: Incidental appendectomies at the time of benign gynecologic procedures do not increase postoperative complication or hospital stay. If incidental appendectomies were included in all abdominal hysterectomies, it could potentially decrease mortality from appendicitis in the elderly.