title: Comparison of outcomes of laparoscopic versus open appendectomy in children: data from the Nationwide Inpatient Sample (NIS), 2006-2008.
abstract: BACKGROUND
  The benefits of laparoscopic appendectomy (LA) remain undefined as compared to open appendectomy (OA) in children, particularly in cases of perforated appendicitis. The purpose of the present study was to evaluate the outcomes of LA versus OA in perforated and nonperforated appendicitis in children.
  
  
  METHODS
  Using the Nationwide Inpatient Sample database, we evaluated the clinical data of children (<18 years old) who underwent LA and OA from 2006 to 2008. Incidental and elective appendectomies were excluded.
  
  
  RESULTS
  A total of 212,958 children underwent urgent appendectomy in the United States during these years. The overall rate of perforated appendicitis was 27.7, and 56.9% of all cases were performed laparoscopically. In nonperforated cases, LA was associated with comparable overall complication rate (LA: 2.56 vs. OA: 2.66%; p = 0.26), shorter length of hospital stay (LOS, LA: 1.6 vs. OA: 2.0 days; p < 0.01), comparable mortality (LA: 0.01 vs. OA: 0.02%; p = 0.25); and higher hospital charges (LA: $20,328 vs. OA: $16,830; p < 0.01) compared to OA. In perforated cases, LA had a lower overall complication rate (LA: 16.03 vs. OA: 18.07%; p < 0.01), shorter LOS (LA: 5.1 vs. OA: 5.8 days; p < 0.01), lower mortality (LA: 0.0% versus OA: 0.06%; p < 0.01), and similar hospital charges (LA: $33,361 versus OA: $33, 662; p = 0.71) compared to OA.
  
  
  CONCLUSIONS
  LA is safe in children with acute perforated and nonperforated appendicitis, and is associated with shorter hospital stay than OA. The laparoscopic approach is associated with lower morbidity and mortality in perforated cases. However, in nonperforated cases, these benefits are modest and are associated with higher hospital charges.
authors.affiliation: Department of Surgery, University of California, Irvine, Medical Center, 333 City Blvd. West, Suite 700, Orange, CA 92868, USA.
authors.forename: Hossein
authors.initials: H
authors.lastname: Masoomi
authors.forename: Steven
authors.initials: S
authors.lastname: Mills
authors.forename: Matthew O
authors.initials: MO
authors.lastname: Dolich
authors.forename: Noor
authors.initials: N
authors.lastname: Ketana
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Carmichael
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000379:methods* / Q000706:statistics & numerical data; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States