Laparoscopic versus open appendectomy in children: outcomes comparison based on a statewide analysis

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).