Appendicectomy at a children's hospital: what has changed over a decade?
BACKGROUND
Appendicectomy remains the most common abdominal emergency procedure performed by surgeons. We reviewed appendicectomies for the calendar years 1999 and 2009 to assess any changes in the referral, presentation and management at a tertiary paediatric institution.


METHODS
We performed a retrospective chart review on all appendicectomies at our institution in 1999 and 2009. Patients were identified using the International Classification of Diseases 9 and 10 Australian Modification codes. A P-value of <0.05 was considered significant.


RESULTS
The number of emergency appendicectomies more than doubled from 126 to 296 between 1999 and 2009. The rate of laparoscopic appendicectomy increased from <1% in 1999 to 70.3% in 2009. Overall, the mean patient age increased from 8.6 years in 1999 to 9.68 in 2009 (P = 0.005). There was an increase in the proportion (19.8% versus 39.5%, P < 0.001) and age (5.3 versus 8.8, P < 0.0001) of patients referred via inter-hospital transfers between the two time periods. In 2009, laparoscopic surgery required on average 13.6 min longer than open surgery. This increase in surgical duration was offset by a decrease in the length of stay (5.0 ± 0.7 versus 3.5 ± 0.3, P < 0.0001).


CONCLUSIONS
Our institution has experienced an extraordinary rise in the number of appendicectomies performed, which cannot be explained by an increase in the local paediatric population alone. There appears to have been dramatic shift in the surgical care of children to our tertiary paediatric centre. The majority of appendicectomies in 2009 were laparoscopic, with a reduced length of stay despite longer operative times.
Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
Brooke E
BE
Wilson
Lukas
L
Cheney
Bhavesh
B
Patel
Andrew J A
AJ
Holland
D000293:Adolescent; D001062:Appendectomy / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D001064:Appendicitis / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data / Q000639:trends*; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D009517:New South Wales; D061646:Operative Time; D010360:Patient Transfer / Q000706:statistics & numerical data / Q000639:trends*; D012017:Referral and Consultation / Q000639:trends*; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data / Q000639:trends*