title: Pediatric laparoscopic appendectomy: a population-based study of trends, associations, and outcomes.
abstract: OBJECTIVE
  We performed a population-based study to analyze the trends, associations, and outcomes of laparoscopic appendectomy (LA) in the Canadian universal health care setting.
  
  
  METHODS
  Children younger than 18years coded for urgent appendectomy in the discharge abstract database of the Canadian Institute of Health Information during 2004-2010 were analyzed. The Cochran-Armitage test, logistic regression, and quintile regression were used to perform the necessary analyses.
  
  
  RESULTS
  41,405 children were studied. LA incidence steadily increased from 28.8% to 66.4%, p<.0001. Conversion rates significantly decreased, while LA for perforated appendicitis significantly increased. LA occurred significantly less in younger patients [OR 0.24 (<5years), OR 0.45 (6-11 years)], males [OR 0.79], and operations by a general surgeon [OR 0.33]. Rural domicile, socioeconomic status, and hospital type had no effect. LA decreased hospital stay for simple appendicitis by one day beginning in 2006, and by variable durations for perforated appendicitis throughout the study period.
  
  
  CONCLUSIONS
  The incidence of LA in Canada has more than doubled. Older children, females, and patients treated by pediatric surgeons are more likely to receive LA, while domicile, socioeconomic status, and hospital type have no effect. LA reduced hospital stay for both simple and perforated appendicitis.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Li Hsia Alicia
authors.initials: LH
authors.lastname: Cheong
authors.affiliation: Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: Sherif.Emil@McGill.ca.
authors.forename: Sherif
authors.initials: S
authors.lastname: Emil
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000367:Age Factors; D001062:Appendectomy / Q000706:statistics & numerical data / Q000639:trends*; D001064:Appendicitis / Q000601:surgery*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000706:statistics & numerical data / Q000639:trends*; D007902:Length of Stay; D008297:Male; D012111:Residence Characteristics; D012189:Retrospective Studies; D012424:Rural Population; D012923:Social Class
keywords: Appendectomy; Association; Canada; Laparoscopic; Pediatric; Trends