title: Hospital preference of laparoscopic versus open appendectomy: Effects on outcomes in simple and complicated appendicitis.
abstract: OBJECTIVE
  We hypothesize that laparoscopic (LA) or open appendectomy (OA) outcomes are associated with hospital procedure preference.
  
  
  METHODS
  We queried Kids' Inpatient Database (1997-2009) for simple (ICD-9-CM 540.9) and complicated (540.0, 540.1) appendicitis.
  
  
  RESULTS
  On PS-matched analysis of simple appendicitis (91,118 LA vs. 97,496 OA), LA had increased transfusion (1.7) rates, but lower wound infection (0.6) and perforation/laceration (0.3) rates. LA had shorter length of stay (LOS; 1.7 vs. 2.1days), but higher total charges (TC; 19,501 vs. 13,089 USD) and cost (7121 vs. 5968) vs. OA. For complicated appendicitis (28,793 LA vs. 30,782 OA), LA had increased nausea/vomiting rates (1.9), but lower wound infection (0.5) and transfusion (0.6) rates. LA had shorter LOS (5.1 vs. 5.9), but higher TC (32,251 vs. 28,209). MVA demonstrated shorter LOS (0.9) for LA at laparoscopic-preferring hospitals vs. open-preferring hospitals for simple appendicitis. For complicated appendicitis, higher complication rates (1.1) were associated with OA at laparoscopic-preferring hospitals. Laparoscopic-preferring hospitals had higher TC in all categories.
  
  
  CONCLUSIONS
  Complications and resource utilization for appendicitis are associated with surgical technique and hospital procedure preference. Laparoscopic-preferring hospitals had higher complication rates with OA for complicated appendicitis and higher charges regardless of appendectomy technique or appendicitis type.
  
  
  METHODS
  2c, Outcomes Research.
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Jun
authors.initials: J
authors.lastname: Tashiro
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Einstein
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Perez
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Steven N
authors.initials: SN
authors.lastname: Bronson
authors.affiliation: South Florida Pediatric Surgeons, P.A., Plantation, FL.
authors.forename: David S
authors.initials: DS
authors.lastname: Lasko
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL. Electronic address: JSola@med.miami.edu.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Sola
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D001803:Blood Transfusion; D002648:Child; D016208:Databases, Factual; D005260:Female; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D017713:Platelet Transfusion; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: Appendectomy; Outcomes research