Comparing the cost and outcomes of laparoscopic versus open appendectomy for perforated appendicitis in children.
Although laparoscopic appendectomy (LA) is accepted treatment for perforated appendicitis (PA) in children, concerns remain whether it has equivalent outcomes with open appendectomy (OA) and increased cost. A retrospective review was conducted of patients younger than age 17 years treated for PA over a 12.5-year period at a tertiary medical center. Patient characteristics, preoperative indices, and postoperative outcomes were analyzed for patients undergoing LA and OA. Of 289 patients meeting inclusion criteria, 86 had LA (29.8%) and 203 OA (70.2%), the two groups having equivalent patient demographics and preoperative indices. Inpatient costs were not significantly different between LA and OA. LA had a lower rate of wound infection (1.2 vs. 8.9%, P = 0.017), total parenteral nutrition use (23.3 vs. 50.7%, P < 0.0001), and length of stay (5.56 ± 2.38 days vs. 7.25 ± 3.77 days, P = 0.0001). There was no significant difference in the rate of postoperative organ space abscess, surgical re-exploration, or rehospitalization. In children with PA, LA had fewer surgical site infections and shorter lengths of hospital stay compared with OA without an increase in inpatient costs.
Department of Surgery, Section of Pediatric Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Leslie B
LB
Groves
Mitchell R
MR
Ladd
Jared R
JR
Gallaher
John
J
Swanson
Robert D
RD
Becher
Thomas
T
Pranikoff
Lucas P
LP
Neff
D000293:Adolescent; D001062:Appendectomy / Q000191:economics* / Q000379:methods; D001064:Appendicitis / Q000191:economics / Q000601:surgery*; D002140:California; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D004180:Direct Service Costs; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D011183:Postoperative Complications / Q000191:economics; D012189:Retrospective Studies; D016896:Treatment Outcome