Laparoscopic vs open appendectomy in children: outcomes comparison based on age, sex, and perforation status.

Archives of surgery (Chicago, Ill. : 1960)

PubMedID: 21690438

Lee SL, Yaghoubian A, Kaji A. Laparoscopic vs open appendectomy in children: outcomes comparison based on age, sex, and perforation status. Arch Surg. 2011;146(10):1118-21.
HYPOTHESIS
Outcomes of laparoscopic appendectomy (LA) will be similar to open appendectomy (OA) in children of all ages.

DESIGN
Retrospective cohort study using discharge abstract data.

SETTING
Twelve regional hospitals in Southern California.

PATIENTS
Seven thousand six hundred fifty patients underwent appendectomy for acute appendicitis (LA = 3551, OA = 4099).

INTERVENTION
Laparoscopic appendectomy or OA.

MAIN OUTCOME MEASURES
Thirty-day morbidity (wound infection, abscess drainage, and readmission) and length of hospitalization.

RESULTS
Use of laparoscopy increased from 22% in 1998 to 70% in 2007. Overall, patients undergoing LA were older (mean [SD] age, 12.8 [3.2] vs 10.4 [3.7] years; P < .001) and had a lower perforation rate (24% vs 34%; P < .001). Multivariable logistic regression demonstrated a decreased odds ratio for wound infection (odds ratio, 0.6; 95% confidence interval, 0.5-0.8) and abscess drainage (odds ratio, 0.6; 95% confidence interval, 0.4-0.7) following LA compared with OA. Multivariable linear regression also showed decreased length of hospitalization following LA compared with OA.

CONCLUSION
Now the preferred operation for children with appendicitis, LA was associated with a decreased risk of wound infection, abscess drainage, and length of hospitalization compared with OA.