Trend, variability, and outcome of open vs. laparoscopic appendectomy based on a large administrative database Mario Saia • Alessandra Buja • Tatjana Baldovin • Giampietro Callegaro • Paolo Sandona ` • Domenico Mantoan • Vincenzo Baldo Received: 21 July 2011 / Accepted: 23 January 2012 Ó Springer Science+Business Media, LLC 2012 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 adminis- trative database, to compare the effectiveness and effi- ciency 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 laparo- scopic 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 under- taken 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 appro- priateness 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. Keywords Appendicitis Á Health-care surveys Á Disease management Á Delivery of health care Á Surgical approach Á Trend and variability Ever since it was introduced by McBurney in 1894, appendectomy has been the treatment of choice for acute appendicitis [1]. It soon became one of the most frequently performed surgical procedures and the surgical technique remained virtually unchanged for over a century, as it combined therapeutic efficacy with low morbidity and mortality rates [2]. The evolution of endoscopic surgery led to the idea that appendectomy could be performed lapa- roscopically, a procedure first described by Semm in 1983 [3]. The recent Cochrane Collaboration [4] review com- pared the diagnostic and therapeutic effects of laparoscopic (LA) and conventional open appendectomy (OA). It found that in those clinical settings where surgical expertise and equipment are available and affordable, diagnostic lapa- roscopy and LA (in combination or separately) seem to have various advantages over OA; young females, the obese, and patients who are employed all seem to benefit particularly from LA. Conventional appendectomy should not be considered ‘‘wrong,’’ however, because the differ- ence between the two techniques is rather small and depends largely on the patient’s characteristics and the surgeon’s expertise. There is also still some debate on the M. Saia Á D. Mantoan EuroHealth Net, Veneto Region Health Directorate, Palazzo Molin, San Polo, 2513 - 30125 Venezia (VE), Italy A. Buja (&) Á T. Baldovin Á P. Sandona ` Á V. Baldo Department of Environmental Medicine and Public Health, University of Padova, Via Loredan, 18, 35128 Padova, Italy e-mail: alessandra.buja@unipd.it G. Callegaro EuroHealth Net, Local Health Unit N°8, Via Forestuzzo 41, 31011 Asolo, Veneto Region, Italy 123 Surg Endosc DOI 10.1007/s00464-012-2188-5 and Other Interventional Techniques