A population-based comparison of the post-operative outcomes of open and laparoscopic appendicectomy in children

Francisco J. Schneuer, Susan E. Adams, Jason P. Bentley, Andrew J. A. Holland, Carmen Huckel Schneider, Leslie White, Natasha Nassar

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To assess and compare the post-operative outcomes of open and laparoscopic appendicectomy in children.

Design: Record linkage analysis of administrative hospital (Admitted Patient Data Collection) and emergency department (Emergency Department Data Collection) data.

Participants, setting: Children under 16 years of age who underwent an appendicectomy in a public or private hospital in New South Wales between January 2002 and December 2013.

Main outcome measures: Association between type of appendicectomy and post-operative complications within 28 days of discharge, adjusted for patient characteristics and type of hospital.

Results: Of 23 961 children who underwent appendicectomy, 19 336 (81%) had uncomplicated appendicitis and 4625 (19%) had appendicitis complicated by abscess, perforation, or peritonitis. The proportion of laparoscopic appendicectomies increased from 11.8% in 2002 to 85.8% in 2013. In cases of uncomplicated appendicitis, laparoscopic appendicectomy was associated with more post-operative complications (mostly symptomatic re-admissions or emergency department presentations) than open appendicectomy (7.4% v 5.8%), but with a reduced risk of post-operative intestinal obstruction (adjusted odds ratio [aOR], 0.59; 95% CI, 0.36–0.97). For cases of complicated appendicitis, the risk of wound infections was lower for laparoscopic appendicectomy (aOR, 0.67; 95% CI, 0.50–0.90), but not the risks of intestinal obstruction (aOR, 0.97; 95% CI, 0.62–1.52) or intra-abdominal abscess (aOR, 1.06; 95% CI, 0.72–1.55).

Conclusion: Post-appendicectomy outcomes were similar for most age groups and hospital types. Children with uncomplicated appendicitis have lower risk of post-operative bowel obstruction after laparoscopic appendicectomy than after open appendicectomy, but may be discharged before their post-operative symptoms have adequately resolved.
Original languageEnglish
Pages (from-to)80-85
Number of pages6
JournalMedical Journal of Australia
Volume209
Issue number2
DOIs
Publication statusPublished - 16 Jul 2018

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