Appendectomy in the pediatric population-a German nationwide cohort analysis.
BACKGROUND
Meta-analyses indicate advantages of laparoscopic compared to open appendectomy. Nationwide analyses on results of laparoscopic appendectomy are scarce and studies from Germany are not available. This observational cohort study based on a nationwide insurance database was performed to analyze results of pediatric laparoscopic versus open appendectomy in general use.


METHODS
Data were extracted from the largest German statutory health insurance TK (∼9 million clients) in a 3-year period (2010-2012). All patients aged 4-17 years with International Classification of Procedures in Medicine (ICPM) code "appendectomy" were included. Logistic regression analysis for the risk of a surgical complication within 180 postoperative days was performed.


RESULTS
Appendectomy was performed in 8110 patients (52.6 % male; 47.4 % female) and conducted laparoscopically in 75.0 % of the patients (conversion rate = 1.2 %). Laparoscopic compared to open surgery was associated with a shorter length of hospital stay in both uncomplicated and complicated appendicitis. Patients with complicated appendicitis had lower readmission rates for surgical complications after laparoscopic appendectomy and logistic regression analysis confirmed a significantly lower risk of readmission for surgical complications after laparoscopic compared to open operation in adolescents. Pediatric surgeons operated 23.9 % and general surgeons 76.1 % of patients. Laparoscopy was less frequently used and the conversion rate was significantly higher in pediatric surgical departments.


CONCLUSIONS
This first nationwide German cohort study confirms that laparoscopic appendectomy is associated with a less complicated postoperative course compared to open appendectomy, particularly in patients with complicated appendicitis. Pediatric surgeons used laparoscopy less frequently compared to general surgeons. Laparoscopic appendectomy should therefore be further promoted in pediatric surgical centers in Germany.
Center of Pediatric Surgery, Hannover Medical School, Hannover, Germany. gosemann@uniklinik-leipzig.de.|Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany. gosemann@uniklinik-leipzig.de.
Jan-Hendrik
JH
Gosemann
Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany.
A
A
Lange
Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany.
J
J
Zeidler
Representative Office of Lower Saxony, Techniker Health Insurance, Hannover, Germany.
J
J
Blaser
Center of Pediatric Surgery, Hannover Medical School, Hannover, Germany.
C
C
Dingemann
Center of Pediatric Surgery, Hannover Medical School, Hannover, Germany.
B M
BM
Ure
Center of Pediatric Surgery, Hannover Medical School, Hannover, Germany.|Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany.
M
M
Lacher
D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005858:Germany; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology
Appendicitis; Children; Complication; Laparoscopy; Open surgery