TY - JOUR

T1 - Appendectomy in the pediatric population

T2 - A German nationwide cohort analysis

AU - Gosemann, Jan Hendrik

AU - Lange, Alexander

AU - Zeidler, Jan

AU - Blaser, Jochen

AU - Dingemann, Carmen

AU - Ure, B. M.

AU - Lacher, M.

N1 - Publisher Copyright: © 2016, Springer-Verlag Berlin Heidelberg.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background: Meta-analyses indicate advantages of laparoscopic compared to open appendectomy. Nationwide analyses on results of laparoscopic appendectomy are scarce and studies from Germany are not available. This observational cohort study based on a nationwide insurance database was performed to analyze results of pediatric laparoscopic versus open appendectomy in general use. Methods: Data were extracted from the largest German statutory health insurance TK (∼9 million clients) in a 3-year period (2010–2012). All patients aged 4–17 years with International Classification of Procedures in Medicine (ICPM) code “appendectomy” were included. Logistic regression analysis for the risk of a surgical complication within 180 postoperative days was performed. Results: Appendectomy was performed in 8110 patients (52.6 % male; 47.4 % female) and conducted laparoscopically in 75.0 % of the patients (conversion rate = 1.2 %). Laparoscopic compared to open surgery was associated with a shorter length of hospital stay in both uncomplicated and complicated appendicitis. Patients with complicated appendicitis had lower readmission rates for surgical complications after laparoscopic appendectomy and logistic regression analysis confirmed a significantly lower risk of readmission for surgical complications after laparoscopic compared to open operation in adolescents. Pediatric surgeons operated 23.9 % and general surgeons 76.1 % of patients. Laparoscopy was less frequently used and the conversion rate was significantly higher in pediatric surgical departments. Conclusion: This first nationwide German cohort study confirms that laparoscopic appendectomy is associated with a less complicated postoperative course compared to open appendectomy, particularly in patients with complicated appendicitis. Pediatric surgeons used laparoscopy less frequently compared to general surgeons. Laparoscopic appendectomy should therefore be further promoted in pediatric surgical centers in Germany.

AB - Background: Meta-analyses indicate advantages of laparoscopic compared to open appendectomy. Nationwide analyses on results of laparoscopic appendectomy are scarce and studies from Germany are not available. This observational cohort study based on a nationwide insurance database was performed to analyze results of pediatric laparoscopic versus open appendectomy in general use. Methods: Data were extracted from the largest German statutory health insurance TK (∼9 million clients) in a 3-year period (2010–2012). All patients aged 4–17 years with International Classification of Procedures in Medicine (ICPM) code “appendectomy” were included. Logistic regression analysis for the risk of a surgical complication within 180 postoperative days was performed. Results: Appendectomy was performed in 8110 patients (52.6 % male; 47.4 % female) and conducted laparoscopically in 75.0 % of the patients (conversion rate = 1.2 %). Laparoscopic compared to open surgery was associated with a shorter length of hospital stay in both uncomplicated and complicated appendicitis. Patients with complicated appendicitis had lower readmission rates for surgical complications after laparoscopic appendectomy and logistic regression analysis confirmed a significantly lower risk of readmission for surgical complications after laparoscopic compared to open operation in adolescents. Pediatric surgeons operated 23.9 % and general surgeons 76.1 % of patients. Laparoscopy was less frequently used and the conversion rate was significantly higher in pediatric surgical departments. Conclusion: This first nationwide German cohort study confirms that laparoscopic appendectomy is associated with a less complicated postoperative course compared to open appendectomy, particularly in patients with complicated appendicitis. Pediatric surgeons used laparoscopy less frequently compared to general surgeons. Laparoscopic appendectomy should therefore be further promoted in pediatric surgical centers in Germany.

KW - Appendicitis

KW - Children

KW - Complication

KW - Laparoscopy

KW - Open surgery

UR - http://www.scopus.com/inward/record.url?scp=84964562206&partnerID=8YFLogxK

U2 - 10.1007/s00423-016-1430-3

DO - 10.1007/s00423-016-1430-3

M3 - Article

C2 - 27118213

AN - SCOPUS:84964562206

VL - 401

SP - 651

EP - 659

JO - Langenbeck's Archives of Surgery

JF - Langenbeck's Archives of Surgery

SN - 1435-2443

IS - 5

ER -