OBJECTIVES: Appendectomy is a common surgical procedure and minimally invasive approach is considered a standard treatment. However, the use of robotic-assisted (RAS) appendectomy is currently limited, and there is a lack of studies comparing it to existing techniques. This study aims to characterize and analyze the trends in appendectomy cases in the US, and compare the utilization and conversion rates of open, laparoscopic (LAP), and RAS appendectomy.

METHODS: A retrospective database study was conducted using the PINC AI^TM (Premier) healthcare database from 2018 to 2021. Patient and hospital characteristics were examined, including gender, age, Charlson Comorbidity Index (CCI), emergent/elective status, payer, hospital teaching status, urban/rural and region. We applied propensity score matching to compare conversion rates to open surgeries between LAP and RAS adjusted for patient and hospital characteristics.

RESULTS: A total of 324,993 appendectomy patients were identified, showing a decrease in appendectomy patients by 21.6% from 2018 to 2021. LAP was the most utilized modality (88.9% in 2021). RAS utilization increased 1.2 times from 1.8% to 3.3%, while open appendectomies decreased from 9.3% to 7.7%. More elderly patients (≥65 years) underwent RAS compared to LAP (22.9% vs 12.2%) and had a higher comorbidity index (CCI ≥2) (27.4% vs 7.9%). LAP appendectomies were more common in emergent cases (90.1% vs 31.6%) and were less common in urban hospitals (86.4% vs 94.7%). Conversion rates to open surgery were lower for RAS compared to LAP (6.3% vs 13.6%, p<0.001).

CONCLUSIONS: LAP appendectomy continues to be the most commonly used modality from 2018 to 2021. Patients undergoing RAS were of higher age and had a higher comorbidity index. While RAS appendectomy rates remain low, RAS shows promise as an alternative approach due to its lower conversion rates to open surgery. Further research to study clinical outcomes of RAS in appendectomy surgeries is warranted.