Introduction: Appendectomy remains one of the most common emergency surgical procedures in the United States. Advances in diagnostics, evolving surgical approaches, and increased interest in conservative management have influenced its clinical utilization. This study aims to evaluate national trends in appendectomy, the use of laparoscopic, open, and robotic approaches, and to assess demographic and socioeconomic factors affecting these patterns. Methods: We conducted a cross-sectional analysis using the National Inpatient Sample (NIS) from 2016 to 2022. Patients diagnosed with appendicitis and who underwent appendectomy were identified using ICD-10 codes. Temporal trends in surgical approaches and associations with demographic and clinical variables were analyzed using descriptive statistics and multivariable logistic regression. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Analyses were performed using R 4.2.0, with significance set at p< 0.05. Results: Among 1,035,444 patients with appendicitis, 843,909 (81.5%) underwent appendectomy. Laparoscopic appendectomy was the dominant approach (92%), with a decreasing trend in open surgeries (from 11.0% to 4.9%) and increasing use of robotic procedures (from 0.05% to 1.45%) over time. The overall appendectomy rate declined from 85.0% in 2016 to 77.6% in 2022. Hispanic ethnicity (OR: 1.02) and lower income (OR: 1.01) were associated with higher odds of surgery, while age ≥65 (OR: 0.85) and Black race (OR: 0.94) were linked to lower odds. Rural hospitals showed significantly lower adoption of laparoscopic and robotic methods. Higher Elixhauser Comorbidity Index (ECI ≥5) was associated with longer hospital stays and adverse discharge outcomes. Conclusions: Appendectomy rates in the U.S. are declining, especially for open and laparoscopic approaches, while robotic surgery use is rising. Socioeconomic and racial disparities persist in access to surgical care and outcomes. These findings emphasize the need for equitable surgical access and further research into optimizing management strategies for appendicitis.
Seifi et al. (Sun,) studied this question.