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Pediatric laparoscopic appendectomy: a population-based study of trends, associations, and outcomes
Li Hsia Alicia Cheong1, Sherif Emil1
1Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Insights
Laparoscopic appendectomy (LA) in Canada more than doubled for children, with increased use for perforated cases. This approach reduced hospital stays for both simple and perforated appendicitis.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Surgical Outcomes
Background:
- Appendectomy is a common emergency surgery for children.
- Laparoscopic appendectomy (LA) offers potential benefits over open surgery.
- Trends in LA adoption and outcomes in pediatric populations require investigation.
Purpose of the Study:
- To analyze trends, associations, and outcomes of laparoscopic appendectomy (LA) in Canadian children.
- To evaluate the impact of LA on hospital stay for appendicitis in a universal health care setting.
Main Methods:
- Population-based study of children (<18 years) undergoing urgent appendectomy from 2004-2010 using Canadian Institute of Health Information data.
- Statistical analyses included Cochran-Armitage test, logistic regression, and quintile regression.
Main Results:
- LA incidence increased from 28.8% to 66.4% (p<.0001).
- LA was less common in younger children, males, and procedures by general surgeons.
- LA reduced hospital stay for simple appendicitis by one day and showed variable reductions for perforated appendicitis.
Conclusions:
- Laparoscopic appendectomy (LA) utilization in Canadian children more than doubled during the study period.
- Older children, females, and those treated by pediatric surgeons were more likely to receive LA.
- LA was associated with reduced hospital stay for both simple and perforated appendicitis.
Purpose:
We performed a population-based study to analyze the trends, associations, and outcomes of laparoscopic appendectomy (LA) in the Canadian universal health care setting.
Methods:
Children younger than 18years coded for urgent appendectomy in the discharge abstract database of the Canadian Institute of Health Information during 2004-2010 were analyzed. The Cochran-Armitage test, logistic regression, and quintile regression were used to perform the necessary analyses.
Results:
41,405 children were studied. LA incidence steadily increased from 28.8% to 66.4%, p<.0001. Conversion rates significantly decreased, while LA for perforated appendicitis significantly increased. LA occurred significantly less in younger patients [OR 0.24 (<5years), OR 0.45 (6-11 years)], males [OR 0.79], and operations by a general surgeon [OR 0.33]. Rural domicile, socioeconomic status, and hospital type had no effect. LA decreased hospital stay for simple appendicitis by one day beginning in 2006, and by variable durations for perforated appendicitis throughout the study period.
Conclusions:
The incidence of LA in Canada has more than doubled. Older children, females, and patients treated by pediatric surgeons are more likely to receive LA, while domicile, socioeconomic status, and hospital type have no effect. LA reduced hospital stay for both simple and perforated appendicitis.
