CAPS PaperHospital preference of laparoscopic versus open appendectomy: Effects on outcomes in simple and complicated appendicitis☆
Section snippets
Background
Acute appendicitis is the most common surgical emergency in children [1], [2]. While open appendectomy (OA) has remained a mainstay for treatment, the use of laparoscopic appendectomy (LA) has increased gradually since its initial description in adults in 1983 and in children in 1992 [3], [4]. Consensus regarding the treatment of choice in children with acute appendicitis however, is yet to be achieved [1], [5], [6].
For the adult population, LA has become widely accepted over OA owing to
Materials and methods
The Kids' Inpatient Database (KID) is a sample of pediatric discharges, maintained by the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Quality and Research. Each triennial release contains information on 2 to 3 million unweighted cases from up to 5128 US hospitals, with a weighted total of 7.4 million cases in 2009. Diagnoses and procedures from each hospitalization are coded using the International Classification of Disease, 9th revision, Clinical Modification
Results
Cases of simple appendicitis (298,653) were treated with LA (43%) or OA (57%) with 19 combined in-hospital mortalities. Cases of complicated appendicitis (120,848) were treated with LA (34%) or OA (66%) with 34 combined in-hospital mortalities. For additional demographic and clinical characteristics, see Table 1.
On PS-matched analysis of simple appendicitis (91,118 LA vs. 97,496 OA), LA was associated with an increased packed red blood cell transfusion (odds ratio [95% confidence interval]:
Discussion
Our analysis demonstrated several advantages to performing LA over OA in cases of simple and complicated appendicitis in children. First, SSIs were less common with LA in both types of appendicitis after matching cases based on comorbid risk. This finding is congruent with multiple previous studies, primarily based in the adult literature, which demonstrate the same advantage [9], [16], [18], [19], [20], [22], [28], [38], [39], [40]. Lower SSI rates are most likely attributed to smaller
Conclusions
On a large-scale, population-based analysis of matching cases based on comorbid risk factors and case severity, LA is demonstrated to have considerable advantages over OA in simple and complicated appendicitis. Evaluating facility preference demonstrated that procedure familiarity determined length and cost of hospitalization, as well as the incidence of complications. As minimally invasive surgery becomes increasingly more common in pediatric abdominal procedures, appendectomy should follow
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2020, Journal of Surgical ResearchCitation Excerpt :During this time, the use of laparoscopy has become conventional, but adoption has been and remains variable.21,31 Furthermore, the degree of comfort with laparoscopy influenced decisions of converting to open appendectomy at higher rates earlier in the study period than is observed today.32 Appendectomies in children are now routinely performed and completed laparoscopically for both simple and complicated appendicitis.6,33
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2018, Journal of Pediatric SurgeryEffect of hospital type on the treatment of acute appendicitis in teenagers
2018, Journal of Pediatric SurgeryCitation Excerpt :Rates of laparoscopy were not significantly different between hospital types; however, adult hospitals had significantly higher rates of open appendectomy. This trend is similar to the findings of a recent analysis of the KID database which found that open appendectomy was performed more often in non-children's hospitals compared to children's hospitals for simple (58.5% vs. 38.7%) and complicated (69.5% vs. 49%) appendicitis. [15]. Tian et al. found that children's hospitals had higher rates of laparoscopy compared to non-children's hospitals, and that significant variation exists both within and between children's and non-children's hospitals [10].
Perioperative considerations and complications in pediatric parathyroidectomy
2016, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :This resource is optimal for gaining a population-based perspective, meaning that the inclusion of numerous institutions lends this analysis a greater degree of external validity and generalizability. As a result, there have been myriad analyses evaluating issues among pediatric patients that have utilized this powerful tool [15–23]. Nonetheless, intrainstitutional analyses in which authors have access to individual patient data are necessary to paint a complete picture; therefore, the statistical power and estimates of national incidence afforded by the KID are complementary to other case series available.
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Author disclosure statement: The authors have no financial affiliations to disclose.