Impact of Disease Severity and Age on Outcomes After Laparoscopic Versus Open Appendectomy: A Single-Center Retrospective Cohort Study

Background: Acute appendicitis is one of the most common surgical emergencies worldwide. This study aimed to evaluate the impact of disease severity and age on outcomes after laparoscopic versus open appendectomy and to identify predictors of prolonged hospitalization. Methods: A single-center retrospective cohort study was conducted at a tertiary emergency hospital, including 311 adult patients who underwent appendectomy between January 2020 and December 2024. The primary outcome was length of hospital stay (LOS), with prolonged hospitalization defined as LOS > 7 days. Results: The study included 311 patients (mean age 43.3 ± 18.0 years; 58.5% male), of whom 38.6% had complicated appendicitis. Complicated appendicitis was associated with older age and longer hospitalization. The laparoscopic approach was associated with a significantly shorter LOS compared with the open approach (4.43 ± 2.62 vs. 5.68 ± 3.11 days, p < 0.001). Increasing age independently predicted complicated appendicitis and prolonged hospitalization, while laparoscopy remained independently associated with reduced LOS after adjustment for measured confounders. No significant interaction was observed between surgical approach and disease severity. Conclusions: Disease severity and age are the main determinants of postoperative outcomes in acute appendicitis. Laparoscopic appendectomy was independently associated with shorter hospital stay after adjustment, although this association may be attenuated in more severe disease.