title: National trends in therapeutic approaches and outcomes for pediatric appendicitis: a Taiwanese nationwide cohort study.
abstract: OBJECTIVE
  To define the pattern of therapeutic approaches for pediatric appendicitis and compare their benefits in Taiwan, we analyzed a research-oriented dataset released by the Bureau of National Health Insurance in Taiwan through the Collaboration Center for Health Information Application (CCHIA) to document the impact of the rise of laparoscopic treatment on outcomes.
  
  
  METHODS
  We identified 22,161 patients under 18 years who had been hospitalized with a diagnosis of acute appendicitis between 2007 and 2012 in the CCHIA. Statistical comparisons between the Laparoscopic appendectomy (LA) and open appendectomy (OA, control) groups were computed using a Chi squared test. The odds ratios (ORs) and 95% confidence intervals (CIs) of risk factors for intra-abdominal abscess (IAA) and postoperative bowel obstruction (PBO) were derived from multivariate logistic regression models.
  
  
  RESULTS
  In each respective year, the incidence of LA increased from 29.17% in 2007 to 57.4% in 2012, while that of OA decreased from 70.83% in 2007 to 42.60% in 2012; incidences of non-perforated appendicitis and perforated appendicitis with LA or OA seemed similar. The length of hospitalization between an LA and OA for non-perforated appendicitis was the same, but that with an LA was shorter for perforated appendicitis. The adjusted ORs for IAA and PBO for those patients with perforated and non-perforated appendicitis were 6.30 (95% CI = 5.09-7.78; p < 0.001) and 6.49 (95% CI = 4.45-9.48; p < 0.001); while for those cases undergoing an LA and OA, they were 0.50 (95 % CI = 0.40-0.62; p < 0.001) and 2.07 (95% CI = 1.45-2.95; p < 0.001), respectively. The ORs of IAA and PBO for those patients ≤6 and 7-12 years of age were 1.67 (95% CI = 1.23-2.25; p = 0.001) and 1.20 (95% CI = 0.97-1.49; p = 0.095), and 1.88 (95% CI = 1.08-3.24; p = 0.025) and 1.47 (95% CI = 1.01-2.14; p = 0.043), respectively, compared to those aged 13-18 years.
  
  
  CONCLUSIONS
  Our study demonstrated that young age and perforated appendicitis can affect postoperative IAA and PBO. LA appeared beneficial in reducing the length of hospitalization and postoperative IAA, but had an increasing risk of PBO. Although laparoscopic approach for pediatric appendectomy is increasing in our country, the different hospital levels and pediatric surgeon's laparoscopic experience must be evaluated in further study.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, No 111, Sec 3, Xinglong RD, Taipei, 11696, Taiwan, a72001234@yahoo.com.tw.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Luo
authors.forename: Wen-Kuei
authors.initials: WK
authors.lastname: Chien
authors.forename: Chen-Sheng
authors.initials: CS
authors.lastname: Huang
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Huang
authors.forename: Carlos
authors.initials: C
authors.lastname: Lam
authors.forename: Chin-Wang
authors.initials: CW
authors.lastname: Hsu
authors.forename: Ray-Jade
authors.initials: RJ
authors.lastname: Chen
authors.forename: Kuang-Fu
authors.initials: KF
authors.lastname: Cheng
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001062:Appendectomy / Q000379:methods / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000453:epidemiology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology