title: Cholecystectomy in English children: evidence of an epidemic (1997-2012).
abstract: OBJECTIVE
  The purpose of this study was to calculate the incidence of cholecystectomy among children aged ≤ 16 in England between 1997 and 2012 and to assess trends in risk factors.
  
  
  METHODS
  A nationwide retrospective cohort study using the Hospital Episode Statistics Database for episodes of cholecystectomy in children aged ≤ 16 was performed. Age and sex-specific annual incidence rates were derived using Office of National Statistics mid-year population estimates. Trends in the observed case mix were tested using univariable linear regression.
  
  
  RESULTS
  2808 paediatric cholecystectomies were identified. The incidence of cholecystectomy increased from 0.78/100,000 to 2.7/100,000 (P<0.0001). Sex-specific incidences increased from 1.1 to 4.36/100,000 (P<0.0001) among girls and from 0.48 to 1.13/100,000 (P<0.0001) among boys. There were significant changes in case mix, with an increasing proportion of female cases (69% to 79%, P=0.02), an increase in cases of white ethnicity (48% to 77%, P<0.0001), but only a modest increase in those with a diagnosis of sickle cell anaemia (4% to 6%, P=0.02), and no significant increase in other haemolytic anaemias.
  
  
  CONCLUSIONS
  There has been a three-fold increase in the incidence of paediatric cholecystectomy in England since 1997, with a particular rise among white females. Although data on BMI were not available, the observed effect may be a consequence of increasing levels of teenage obesity.
authors: Department of Paediatric Surgery, King's College Hospital, London, UK. Electronic address: katykhoo@yahoo.com.
authors: Abigail Kate
authors: AK
authors: Khoo
authors: Department of Epidemiology and Biostatistics, Imperial College London. Electronic address: r.cartwright@imperial.ac.uk.
authors: Rufus
authors: R
authors: Cartwright
authors: Quality Observatory, South East Coast SHA. Electronic address: simon.berry@qualityobservatory.nhs.uk.
authors: Simon
authors: S
authors: Berry
authors: Department of Paediatric Surgery, King's College Hospital, London, UK. Electronic address: markdav2@ntlworld.com.
authors: Mark
authors: M
authors: Davenport
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D042882:Gallstones / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
keywords: Children; Cholecystectomy; Gallstones; Hospital Episode Statistics; Obesity