Trend, variability, and outcome of open vs. laparoscopic appendectomy based on a large administrative database
The aim of this study was to ascertain the variability and 9-year trends in the use of laparoscopic surgery for appendicitis using data from a large administrative database, to compare the effectiveness and efficiency of laparoscopic (LA) and open appendectomy, and to ascertain whether different cho...
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| Veröffentlicht in: | Surgical endoscopy 2012-08, Vol.26 (8), p.2353-2359 |
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| creator | Saia, Mario Buja, Alessandra Baldovin, Tatjana Callegaro, Giampietro Sandonà, Paolo Mantoan, Domenico Baldo, Vincenzo |
| description | The aim of this study was to ascertain the variability and 9-year trends in the use of laparoscopic surgery for appendicitis using data from a large administrative database, to compare the effectiveness and efficiency of laparoscopic (LA) and open appendectomy, and to ascertain whether different choices of surgical approach stem from evidence-based recommendations. This was a retrospective cohort study based on administrative data collected from 2000 to 2008 in the Veneto Region (northeastern Italy). Funnel plots were used to display variability between local health units (LHUs). A total of 38,314 appendectomies were performed from 2000 to 2008 in the Veneto Region, 53% of them in males. The laparoscopic procedure was used more often for females than for males of fertile age. There was a significant rising linear trend in the use of LA, with a higher increment among females. The overall regional standardized appendectomy rate was 82.9/10,000. The mean proportion of LAs (27.3%) ranged from 2.8 to 59.4% at different LHUs, and there was no relationship between the volume of procedures undertaken and the proportion of LAs. The proportion of LAs performed in females of reproductive age also varied considerably, on no apparent evidence-based grounds. The analysis of aggregate clinical data is a powerful tool for supporting regional health management units in efforts to improve the quality of medical care and assess the appropriateness of therapeutic or diagnostic approaches in the light of practical guidelines. Variability in the treatment of a given disease that lacks any evidence-based justification remains an important issue in national health systems. |
| doi_str_mv | 10.1007/s00464-012-2188-5 |
| format | Article |
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This was a retrospective cohort study based on administrative data collected from 2000 to 2008 in the Veneto Region (northeastern Italy). Funnel plots were used to display variability between local health units (LHUs). A total of 38,314 appendectomies were performed from 2000 to 2008 in the Veneto Region, 53% of them in males. The laparoscopic procedure was used more often for females than for males of fertile age. There was a significant rising linear trend in the use of LA, with a higher increment among females. The overall regional standardized appendectomy rate was 82.9/10,000. The mean proportion of LAs (27.3%) ranged from 2.8 to 59.4% at different LHUs, and there was no relationship between the volume of procedures undertaken and the proportion of LAs. The proportion of LAs performed in females of reproductive age also varied considerably, on no apparent evidence-based grounds. The analysis of aggregate clinical data is a powerful tool for supporting regional health management units in efforts to improve the quality of medical care and assess the appropriateness of therapeutic or diagnostic approaches in the light of practical guidelines. Variability in the treatment of a given disease that lacks any evidence-based justification remains an important issue in national health systems.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-012-2188-5</identifier><identifier>PMID: 22350240</identifier><identifier>CODEN: SUREEX</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdominal Surgery ; Abscesses ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Appendectomy ; Appendectomy - methods ; Appendectomy - statistics & numerical data ; Appendectomy - trends ; Appendicitis ; Appendicitis - epidemiology ; Appendicitis - surgery ; Biological and medical sciences ; Child ; Child, Preschool ; Cohort analysis ; Digestive system. Abdomen ; Disease ; Endoscopy ; Female ; Gastroenterology ; General aspects ; Gynecology ; Hepatology ; Hospitalization - statistics & numerical data ; Hospitals ; Humans ; Infant ; Investigative techniques, diagnostic techniques (general aspects) ; Italy - epidemiology ; Laparoscopy ; Laparoscopy - methods ; Laparoscopy - statistics & numerical data ; Laparoscopy - trends ; Length of Stay ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; Performance evaluation ; Proctology ; Retrospective Studies ; Sex Distribution ; Stomach, duodenum, intestine, rectum, anus ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Trends ; Young Adult</subject><ispartof>Surgical endoscopy, 2012-08, Vol.26 (8), p.2353-2359</ispartof><rights>Springer Science+Business Media, LLC 2012</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c402t-379e83dbebbff2251ee102565cc5df48cd81aff8ee59df54a1444500507f08d63</citedby><cites>FETCH-LOGICAL-c402t-379e83dbebbff2251ee102565cc5df48cd81aff8ee59df54a1444500507f08d63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-012-2188-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-012-2188-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26207721$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22350240$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Saia, Mario</creatorcontrib><creatorcontrib>Buja, Alessandra</creatorcontrib><creatorcontrib>Baldovin, Tatjana</creatorcontrib><creatorcontrib>Callegaro, Giampietro</creatorcontrib><creatorcontrib>Sandonà, Paolo</creatorcontrib><creatorcontrib>Mantoan, Domenico</creatorcontrib><creatorcontrib>Baldo, Vincenzo</creatorcontrib><title>Trend, variability, and outcome of open vs. laparoscopic appendectomy based on a large administrative database</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>The aim of this study was to ascertain the variability and 9-year trends in the use of laparoscopic surgery for appendicitis using data from a large administrative database, to compare the effectiveness and efficiency of laparoscopic (LA) and open appendectomy, and to ascertain whether different choices of surgical approach stem from evidence-based recommendations. This was a retrospective cohort study based on administrative data collected from 2000 to 2008 in the Veneto Region (northeastern Italy). Funnel plots were used to display variability between local health units (LHUs). A total of 38,314 appendectomies were performed from 2000 to 2008 in the Veneto Region, 53% of them in males. The laparoscopic procedure was used more often for females than for males of fertile age. There was a significant rising linear trend in the use of LA, with a higher increment among females. The overall regional standardized appendectomy rate was 82.9/10,000. The mean proportion of LAs (27.3%) ranged from 2.8 to 59.4% at different LHUs, and there was no relationship between the volume of procedures undertaken and the proportion of LAs. The proportion of LAs performed in females of reproductive age also varied considerably, on no apparent evidence-based grounds. The analysis of aggregate clinical data is a powerful tool for supporting regional health management units in efforts to improve the quality of medical care and assess the appropriateness of therapeutic or diagnostic approaches in the light of practical guidelines. Variability in the treatment of a given disease that lacks any evidence-based justification remains an important issue in national health systems.</description><subject>Abdominal Surgery</subject><subject>Abscesses</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Appendectomy</subject><subject>Appendectomy - methods</subject><subject>Appendectomy - statistics & numerical data</subject><subject>Appendectomy - trends</subject><subject>Appendicitis</subject><subject>Appendicitis - epidemiology</subject><subject>Appendicitis - surgery</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cohort analysis</subject><subject>Digestive system. Abdomen</subject><subject>Disease</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>General aspects</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infant</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Italy - epidemiology</subject><subject>Laparoscopy</subject><subject>Laparoscopy - methods</subject><subject>Laparoscopy - statistics & numerical data</subject><subject>Laparoscopy - trends</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Performance evaluation</subject><subject>Proctology</subject><subject>Retrospective Studies</subject><subject>Sex Distribution</subject><subject>Stomach, duodenum, intestine, rectum, anus</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. 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Abdomen</topic><topic>Disease</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>General aspects</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infant</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Italy - epidemiology</topic><topic>Laparoscopy</topic><topic>Laparoscopy - methods</topic><topic>Laparoscopy - statistics & numerical data</topic><topic>Laparoscopy - trends</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Performance evaluation</topic><topic>Proctology</topic><topic>Retrospective Studies</topic><topic>Sex Distribution</topic><topic>Stomach, duodenum, intestine, rectum, anus</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Trends</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Saia, Mario</creatorcontrib><creatorcontrib>Buja, Alessandra</creatorcontrib><creatorcontrib>Baldovin, Tatjana</creatorcontrib><creatorcontrib>Callegaro, Giampietro</creatorcontrib><creatorcontrib>Sandonà, Paolo</creatorcontrib><creatorcontrib>Mantoan, Domenico</creatorcontrib><creatorcontrib>Baldo, Vincenzo</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Saia, Mario</au><au>Buja, Alessandra</au><au>Baldovin, Tatjana</au><au>Callegaro, Giampietro</au><au>Sandonà, Paolo</au><au>Mantoan, Domenico</au><au>Baldo, Vincenzo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Trend, variability, and outcome of open vs. laparoscopic appendectomy based on a large administrative database</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2012-08-01</date><risdate>2012</risdate><volume>26</volume><issue>8</issue><spage>2353</spage><epage>2359</epage><pages>2353-2359</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><coden>SUREEX</coden><abstract>The aim of this study was to ascertain the variability and 9-year trends in the use of laparoscopic surgery for appendicitis using data from a large administrative database, to compare the effectiveness and efficiency of laparoscopic (LA) and open appendectomy, and to ascertain whether different choices of surgical approach stem from evidence-based recommendations. This was a retrospective cohort study based on administrative data collected from 2000 to 2008 in the Veneto Region (northeastern Italy). Funnel plots were used to display variability between local health units (LHUs). A total of 38,314 appendectomies were performed from 2000 to 2008 in the Veneto Region, 53% of them in males. The laparoscopic procedure was used more often for females than for males of fertile age. There was a significant rising linear trend in the use of LA, with a higher increment among females. The overall regional standardized appendectomy rate was 82.9/10,000. The mean proportion of LAs (27.3%) ranged from 2.8 to 59.4% at different LHUs, and there was no relationship between the volume of procedures undertaken and the proportion of LAs. The proportion of LAs performed in females of reproductive age also varied considerably, on no apparent evidence-based grounds. The analysis of aggregate clinical data is a powerful tool for supporting regional health management units in efforts to improve the quality of medical care and assess the appropriateness of therapeutic or diagnostic approaches in the light of practical guidelines. Variability in the treatment of a given disease that lacks any evidence-based justification remains an important issue in national health systems.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>22350240</pmid><doi>10.1007/s00464-012-2188-5</doi><tpages>7</tpages></addata></record> |
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| subjects | Abdominal Surgery Abscesses Adolescent Adult Aged Aged, 80 and over Appendectomy Appendectomy - methods Appendectomy - statistics & numerical data Appendectomy - trends Appendicitis Appendicitis - epidemiology Appendicitis - surgery Biological and medical sciences Child Child, Preschool Cohort analysis Digestive system. Abdomen Disease Endoscopy Female Gastroenterology General aspects Gynecology Hepatology Hospitalization - statistics & numerical data Hospitals Humans Infant Investigative techniques, diagnostic techniques (general aspects) Italy - epidemiology Laparoscopy Laparoscopy - methods Laparoscopy - statistics & numerical data Laparoscopy - trends Length of Stay Male Medical sciences Medicine Medicine & Public Health Middle Aged Mortality Performance evaluation Proctology Retrospective Studies Sex Distribution Stomach, duodenum, intestine, rectum, anus Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Trends Young Adult |
| title | Trend, variability, and outcome of open vs. laparoscopic appendectomy based on a large administrative database |
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