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Laparoscopy uptake for paediatric appendicectomy: a comparison of general surgeons versus specialist paediatric
G S Bethell1,2, S Adams2, T Johnson1
1University of Southampton, UK.
Insights
Laparoscopic appendicectomy in children has significantly increased, reaching 50% by 2014. Specialist paediatric surgeons use laparoscopy more than general surgeons, especially in younger patients.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Health Services Research
Background:
- Laparoscopic appendicectomy offers benefits like reduced infection and shorter hospital stays compared to open surgery in children.
- Despite evidence, uptake of laparoscopic appendicectomy in pediatric patients in England requires investigation.
Purpose of the Study:
- To report the adoption rate of laparoscopic appendicectomy in children in England.
- To compare the utilization of laparoscopic appendicectomy between general surgeons (GS) and specialist paediatric surgeons (SPS).
Main Methods:
- Analysis of Hospital Episode Statistics data for children under 16 undergoing emergency appendicectomy from 1997 to 2015.
- Comparison of laparoscopic versus open appendicectomy rates between GS and SPS over time, with multivariate analysis of associated factors.
Main Results:
- The rate of laparoscopic appendicectomy increased from 0.8% in 1998 to 50% in 2014.
- In 2014, 41% of cases were performed laparoscopically by GS versus 71% by SPS (p<0.0001).
- Female gender, increasing age, and treatment by SPS were associated with higher laparoscopy use.
Conclusions:
- Laparoscopic appendicectomy rates in children have substantially increased.
- General surgeons performed significantly fewer laparoscopic appendicectomies than specialist paediatric surgeons, even after adjusting for patient factors.
- This disparity in laparoscopic approach utilization was most pronounced in younger children.
Introduction:
Laparoscopy is used in as many as 95% of adult appendicectomies. There is level I evidence showing that it reduces wound infection, postoperative ileus and length of inpatient stay in children compared with the open approach. The aim of this study was to report the uptake of laparoscopy for paediatric appendicectomy in England and to determine whether this was similar for general surgeons (GS) and specialist paediatric surgeons (SPS).
Methods:
Hospital Episode Statistics data were obtained for all children aged <16 years who had an OPCS 4.6 code for emergency appendicectomy from 1997 to 2015 (18 years). Data are analysed to compare rate of laparoscopic vs open procedures for GS and SPS over time and to investigate factors associated with the use of laparoscopy.
Results:
There were 196,987 appendicectomies and where specialty was available, 133,709 (79%) cases were undertaken by GS and 35,141 (21%) by SPS. The rate of cases undertaken with laparoscopy for both specialties combined increased from 0.8% in 1998 to 50% in 2014 (p<0.0001). In 2014, this rate was 41% for GS compared with 71% for SPS (p<0.0001). Female gender (odds ratio (OR)=1.84, 95% confidence interval (CI) 1.80-1.90), increasing age (OR=1.18, 95% CI 1.18-1.19 per year) and treatment by SPS (OR=3.71, 95% CI 3.60-3.82) were all factors positively associated with use of laparoscopy in multivariate analysis.
Conclusions:
There has been a vast increase in the proportion of appendicectomies undertaken laparoscopically in children. Despite adjusting for patient factors, laparoscopy was used significantly less by GS when compared with SPS. This difference is most apparent in younger children.
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