The Value of Incidental Appendectomy in Lower Abdominal Surgery: A Retrospective Study of Taiwan’s National Health Insurance Research Database

Background: Incidental appendectomy (IA) remains a debatable procedure to prevent appendicitis. We used the National Health Insurance Research Database (NHIRD) of Taiwan to compare two groups’ of patients undergoing appendectomies with or without abdominal surgical history to discuss the value of incidental appendectomy. Study design: A retrospective review of the NHIRD of Taiwan was performed for all patients who underwent appendectomies from January 1998 through December 2008. Patients were classified into two groups. Group A patients had history of previous abdominal surgeries and group B patients had not. The savings of any increased costs and morbidity among patients with previous abdominal surgeries would be representative of the benefit of IA. Results: During this period, 245,832 patients underwent appendectomy. The incidence of previous abdominal surgery was 2.59% (6,379 patients). The medical fees for group A were greater than group B (NT$ 45,981.53 vs. NT$ 32,690.49; p< 0.0001). Infection and wound complications (6.71% vs. 4.81%; p< 0.0001), blood transfusion (17.18% vs. 12.89%, p< 0.0001), abdominal drainage (1.47% vs. 0.40%; p< 0.0001), reentering hospital rate (9.11% vs. 2.24%; p< 0.0001) and mortality rate (0.83% vs. 0.13%; p< 0.0001) were significantly greater in group A. Hospital stay (4 and 4 days; p<0.0001) and intensive care unit stay (1 and 1 day; p=0.1211) did not differ significantly between the two groups. Conclusions: In appendix disorder surgeries, patients undergoing the next time low abdominal surgery for appendectomy will increase the medical fees and complication rates than those undergoing the first time surgery. IA is a valuable procedure in low abdominal surgery.