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Outcome after introduction of laparoscopic appendectomy in children: A cohort study
Jan F Svensson1, Barbora Patkova1, Markus Almström1
1Department of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Insights
Laparoscopic appendectomy in children does not improve outcomes or reduce complications compared to open surgery. A perceived shorter hospital stay for laparoscopic procedures was attributed to a general trend, not the surgical method itself.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes Research
- Appendicitis Management
Background:
- Acute appendicitis is a common pediatric condition with ongoing debate regarding optimal surgical treatment.
- Laparoscopic surgery is increasingly adopted, with some data suggesting shorter hospital stays and similar complication rates compared to open procedures.
Purpose of the Study:
- To compare the outcomes of open versus laparoscopic appendectomies in children during a period of surgical transition.
- To evaluate complications, operating time, and postoperative length of stay for both surgical approaches.
Main Methods:
- Retrospective cohort study utilizing prospectively collected data.
- Inclusion of all pediatric patients undergoing surgery for suspected appendicitis between 2006 and 2010.
- Comparison of outcomes between laparoscopic and open appendectomy groups.
Main Results:
- 1745 children were analyzed; 1010 underwent laparoscopic appendectomy.
- No significant differences in postoperative abscesses, wound infections, readmissions, or reoperations were observed between groups.
- While initial analysis suggested shorter stays for laparoscopy, regression analysis indicated this was due to a general trend of decreasing length of stay over time, not the surgical technique.
Conclusions:
- Laparoscopic and open appendectomy demonstrate comparable outcomes regarding complications in pediatric patients.
- The presumed benefit of shorter postoperative length of stay with laparoscopic appendectomy was not substantiated by regression analysis.
- The study highlights the importance of statistical adjustment for temporal trends when evaluating surgical innovations.
Introduction:
Acute appendicitis in children is common and the optimal treatment modality is still debated, even if recent data suggest that laparoscopic surgery may result in shorter postoperative length of stay without an increased number of complications. The aim of the study was to compare the outcome of open and laparoscopic appendectomies during a transition period.
Materials And Methods:
This was a retrospective cohort study with prospectively collected data. All patients who underwent an operation for suspected appendicitis at the Astrid Lindgren Children's Hospital in Stockholm between 2006 and 2010 were included in the study.
Results:
1745 children were included in this study, of whom 1010 had a laparoscopic intervention. There were no significant differences in the rate of postoperative abscesses, wound infections, readmissions or reoperations between the two groups. The median operating time was longer for laparoscopic appendectomy than for open appendectomy, 51 vs. 37minutes (p<0.05). The postoperative length of stay was similar in the two groups. A simple comparison between the groups suggested that laparoscopic appendectomy had a shorter median postoperative length of stay, 43 vs. 57hours (p<0.05). However, there was a trend in time for a shorter postoperative length of stay, and a trend for more of the procedures to be performed laparoscopically over time so on regression analysis, the apparent decrease in length of stay with laparoscopy could be ascribed to the general trend toward decreased length of stay over time, with no specific additional effect of laparoscopy.
Conclusions:
Our data show no difference in outcome between open and laparoscopic surgery for acute appendicitis in children in regard of complications. The initial assumption that the patients treated with laparoscopic surgery had a shorter postoperative stay was not confirmed with linear regression, which showed that the assumed difference was due only to a trend toward shorter postoperative length of stay over time, regardless of the surgical intervention.
