Acute Care SurgerySafety of Laparoscopic Appendectomy in the Setting of Coagulopathy: An ACS-NSQIP Study
Section snippets
Background
The operative management of coagulopathic patients with appendicitis is challenging. Coagulopathy in these patients is most commonly due to the use of antithrombotic agents, but it can also be due to the endotoxin-mediated activation of the extrinsic coagulation pathway caused by the septic process itself.1 The number of patients on antithrombotic therapy (anticoagulants and/or antiplatelet therapy) is rising worldwide as the population ages and the prevalence of cardiovascular disorders
Study design
We queried the ACS-NSQIP Participant Use Data Files from 2014 to 2017. The study met the requirements for our institutional review board exemption status and for the informed consent requirement to be waived due to the deidentified nature of the data. We included all adult patients who underwent emergent appendectomy. ACS-NSQIP defines an emergent procedure as the primary procedure performed during the hospital admission and is designated by the surgeon and/or anesthesiologist as emergent.
Results
A total of 137,429 patients who underwent appendectomy were identified, of which 7049 (5%) had coagulopathy. In patients with coagulopathy, 54.3% had elevated INR, 9.7% with prolonged PTT, 26.3% with decreased platelet count, and 34.2% had a bleeding disorder as defined above. These parameters were not mutually exclusive, and some patients met multiple criteria for coagulopathy. The mean age was 51 ± 20, and 4279 (61%) were male. The most common American Society of Anesthesiology class was III (
Discussion
Our data demonstrate that 89% of patients with coagulopathy who undergo emergent appendectomy (5% of all patients undergoing appendectomy) do so via a laparoscopic approach. LA in this patient group appears to be safe with regard to transfusion requirement and reoperation.
The surgical care of patients with coagulopathy is challenging. Comparative data to guide the management of these patients are limited, although there are several published studies reporting surgical outcomes in patients with
Author Contributions
Ya Zhou: Literature search, study design, manuscript writing. Vida Rastegar: Study design, statistical analysis, manuscript writing. Thomas E. Read: Critical revision of the manuscript. Mazen R. Al-Mansour: Study concept and design, manuscript writing, critical revision.
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