title: National trends in approach and outcomes with appendicitis in children.
abstract: OBJECTIVE
  Appendicitis is one of the most common surgical conditions in children. Laparoscopy has become the standard approach to appendectomy over the past decade. Some critics cite a lack of evidence documenting clear advantages to laparoscopy. To define the pattern of approach compared to outcomes in the United States, we analyzed the Pediatric Health Information System (PHIS) database to document the impact on outcomes with the rise in laparoscopy.
  
  
  METHODS
  After IRB approval, we queried the PHIS database for all patients over 12 years. The percentages of cases performed open (OA) and laparoscopically (LA) were established for each year. Annual complication percentages were identified for wound infection, intra-abdominal abscess, subsequent laparotomy, and obstruction. For each complication, trend comparisons between LA and OA were made with generalized linear models.
  
  
  RESULTS
  There were 111,194 appendectomies with a positive trend in percentage of laparoscopy from 1999 (22.2%) to 2010 (90.8%), P<0.0001. Over 12 years, there were significant differential trends between LA and OA in rates of wound infection, abscesses, bowel obstructions, and laparotomies within 30 days (P<0.0001 for each). There was no trend in wound infection rates within OA over time (P=0.31), while there was a decrease in infection rates within LA over time (P<0.0001).
  
  
  CONCLUSIONS
  On the basis of a national database analysis, laparoscopy has increased for appendectomy in children over the past 12 years and is associated with a significant decrease in post-operative complications.
authors.affiliation: Department of Surgery, Children's Mercy Hospital and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA.
authors.forename: Alessandra C
authors.initials: AC
authors.lastname: Gasior
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.forename: E Marty
authors.initials: EM
authors.lastname: Knott
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
authors.forename: Charles L
authors.initials: CL
authors.lastname: Snyder
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods* / Q000639:trends*; D001064:Appendicitis / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000639:trends; D007813:Laparotomy / Q000009:adverse effects / Q000639:trends; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology