Laparoscopy utilization and outcomes for appendicitis in small children

• Published in: Journal of pediatric surgery Vol. 48; no. 9; pp. 1941 - 1945
• Main Authors: Zwintscher, Nathan P, Johnson, Eric K, Martin, Matthew J, Newton, Christopher R
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2013
• Subjects: Age of Onset; Appendectomy - methods; Appendectomy - trends; Appendectomy - utilization; Appendicitis; Appendicitis - epidemiology; Appendicitis - surgery; Child, Preschool; Databases, Factual; Female; Hospitals, General - statistics & numerical data; Hospitals, Pediatric - statistics & numerical data; Hospitals, Teaching - statistics & numerical data; Humans; Infant; Intestinal Perforation - epidemiology; Intestinal Perforation - surgery; Laparoscopic appendectomy; Laparoscopy; Laparoscopy - trends; Laparoscopy - utilization; Length of Stay - statistics & numerical data; Male; Patient Admission - statistics & numerical data; Pediatrics; Postoperative Complications - epidemiology; Retrospective Studies; Surgery; Treatment Outcome; United States - epidemiology; United States; Laparoscopic appendectomy; Appendicitis; Laparoscopy
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2012.12.039

Abstract Purpose To examine the trends in laparoscopic appendectomy (LA) utilization and outcomes for children 5 years or younger. Methods We studied 16,028 inpatient admissions for children 5 years of age or less undergoing an appendectomy for acute appendicitis in 2000, 2003, and 2006 using the Kids' Inpatient Database (KID). Laparoscopy frequency, hospital length of stay, and complications were reviewed. Results In 2000, 2003 and 2006 appendectomies were done laparoscopically 11.4%, 18.7% and 31.3% of the time, respectively. Children were more likely to undergo LA at a children's hospital ( P < 0.001). LA complications were less likely overall (OR: 0.80, CI: 0.70–0.92, P = 0.002) and in perforated cases (OR: 0.78, CI: 0.67-0.91, P = 0.001). LA decreased hospital length of stay by 0.54 days for all patients and 0.70 days for perforated cases ( P < 0.001). Conclusions Open appendectomy has historically been the standard in children 5 years of age and younger. Laparoscopic appendectomy has slowly gained acceptance for the treatment of appendicitis in smaller children. The use of laparoscopy has increased significantly at all facilities. Furthermore, laparoscopic appendectomy in this age group has a comparatively low complication rate and short hospital length of stay, and is safe in complicated perforated appendicitis cases.