Postoperative Infection Rates Following Laparoscopic Versus Open Appendectomy: A Comparative Study

Luca Moretti¹, Davide Rinaldi², Elisa Conti³

Abstract

Abstract

Background: Appendectomy is among the most common emergency surgical procedures worldwide. While laparoscopic appendectomy is widely adopted, uncertainty persists regarding its real-world advantage over open appendectomy in reducing postoperative infectious complications, particularly across varying disease severity and perioperative workflows.

Objective: To compare postoperative infection rates following laparoscopic versus open appendectomy and identify independent predictors of postoperative infection.

Methods: We conducted a retrospective comparative cohort study including adults (≥18 years) who underwent appendectomy for suspected acute appendicitis between January 2021 and December 2024 across three tertiary hospitals. Patients were grouped by surgical approach (laparoscopic vs open). The primary outcome was any postoperative infection within 30 days, including surgical site infection (SSI) and intra-abdominal abscess. Secondary outcomes included length of stay, readmission, reoperation, and time to antibiotic discontinuation. Multivariable logistic regression adjusted for age, sex, BMI, diabetes, symptom duration, appendicitis severity (uncomplicated vs complicated/perforated), operative time, and timing of prophylactic antibiotics.

Results: A total of 1,842 patients were included (laparoscopic: n=1,276; open: n=566). Overall postoperative infection occurred in 8.9% (n=164). Infection rates were significantly lower in the laparoscopic group compared with the open group (7.1% vs 13.1%; p<0.001). SSI occurred in 4.8% versus 9.9% (p<0.001), and intra-abdominal abscess occurred in 2.6% versus 3.2% (p=0.41) for laparoscopic versus open appendectomy, respectively. After adjustment, laparoscopic appendectomy was associated with reduced odds of postoperative infection (aOR 0.56; 95% CI 0.40–0.77; p<0.001). Complicated appendicitis was the strongest predictor of infection (aOR 3.21; 95% CI 2.36–4.37; p<0.001), followed by prophylactic antibiotic delay >60 minutes before incision (aOR 1.74; p=0.01). Median length of stay was shorter after laparoscopy (2.1 vs 3.4 days; p<0.001), and 30-day readmission was lower (4.3% vs 6.7%; p=0.02).

Conclusion: Laparoscopic appendectomy was associated with significantly lower postoperative infection rates and shorter hospitalization compared with open appendectomy, without a significant difference in intra-abdominal abscess formation. Optimizing perioperative antibiotic timing and prioritizing laparoscopic approaches particularly in uncomplicated cases—may reduce postoperative infectious morbidity.