Surgical approach, cost, and complications of appendectomy in kidney transplant recipients

Kidney transplant recipients (KTR) have greater morbidity and length of stay (LOS) following certain surgical procedures than non-KTR. Given that appendectomy is one of the most common surgical procedures, we investigated differences in outcomes between 1336 KTR and 2,640,247 non-KTR post-appendectomy at transplant and non-transplant centers in the US from 2000–2011, using NIS data and adjusting for patient and hospital level factors. Postoperative complications were identified using ICD9 codes. Among KTR, there were no post-appendectomy in-hospital deaths, compared to a 0.2% in non-KTR (p=0.5). Overall complications were similar among KTR and non-KTR (17.0% vs 11.6%; aOR:0.771.121.61). LOS and costs were greater for KTR compared to non-KTR (LOS ratio 1.191.311.45; cost ratio 1.111.171.26). Only 44.8% of KTR had laparoscopic approach compared to 54.5% of non-KTR, but had similar complication rates (10.6 vs 8.7%, p 0.5). When treated at transplant centers, KTR had similar complications (aOR 0.440.791.43), but longer LOS (ratio 1.211.371.55) and greater hospital-associated costs (ratio 1.191.291.41) than non-KTR. Conversely, at non-transplant centers, KTR and non-KTR had similar complications (aOR 0.751.232.0), LOS (ratio 0.840.961.09), and cost (ratio 0.931.011.10). Contrary to other procedures, KTR did not constitute a high-risk group for patients undergoing appendectomy.