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Laparoscopic versus open appendectomy in children: outcomes comparison based on a statewide analysis
1Division of Pediatric Surgery, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-7098, USA.
Insights
Laparoscopic appendectomy (LA) is preferred for pediatric appendicitis, but slightly increases the risk of abscess drainage. Long-term hospital use remains unaffected by LA compared to open appendectomy (OA).
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Minimally Invasive Surgery
Background:
- Pediatric appendicitis management involves comparing laparoscopic appendectomy (LA) and open appendectomy (OA).
- Understanding differences in hospital utilization and complications is crucial for optimal patient care.
Purpose of the Study:
- To compare hospital utilization and complication rates between LA and OA in pediatric appendicitis.
- To evaluate the long-term impact of surgical approach on readmissions and further procedures.
Main Methods:
- Retrospective analysis of the California Patient Discharge Database (1999-2006).
- Inclusion of children aged 1-18 years with appendicitis, excluding those with significant comorbidities.
- Analysis of initial hospital course, readmissions, and need for additional procedures.
Main Results:
- Laparoscopic appendectomy (LA) use increased from 19% to 52% between 1999 and 2006.
- LA was associated with a higher incidence of postoperative intra-abdominal abscess drainage for both perforated and non-perforated appendicitis compared to open appendectomy (OA).
- Multivariate analysis confirmed an increased risk of abscess drainage after LA (RR 1.81). Readmission lengths were similar between groups.
Conclusions:
- Laparoscopic appendectomy (LA) is the preferred surgical approach for pediatric appendicitis.
- While LA slightly increases the risk of postoperative abscess drainage, this complication rate remains low.
- LA does not significantly impact long-term hospital utilization compared to open appendectomy (OA).
Background:
To compare the differences in hospital utilization and complications between laparoscopic (LA) and open appendectomy (OA) for pediatric appendicitis.
Methods:
A retrospective study from 1999 to 2006 of children aged 1 to 18 y with appendicitis, from the California Patient Discharge Database was performed. Children with significant comorbidities were excluded. Initial hospital course, subsequent readmissions, and the need for additional procedures were analyzed.
Results:
The use of LA increased steadily from 19% in 1999 to 52% in 2006. Overall, 95,806 children were studied. Readmissions were tracked over a median period of 3 y. LA was associated with increased need for postoperative intra-abdominal abscess drainage for both perforated appendicitis (4.9% versus 3.8%, P<0.001) and nonperforated appendicitis (0.6% versus 0.3%, P<0.001) compared with OA. Multivariate regression showed an increased risk of postoperative abscess drainage for children after LA compared with OA (RR 1.81, 99% CI 1.41-2.27). However, the lengths of readmission hospitalizations were the same between the two groups (5.8 versus 5.7 d, P=NS).
Conclusion:
LA has become the preferred operation for pediatric appendicitis. The need for postoperative abscess drainage is small, and laparoscopy appears to increase this risk slightly. However, LA did not affect long-term hospital utilizations.
