Laparoscopic vs open appendectomy in children: outcomes comparison based on age, sex, and perforation status.

HYPOTHESIS Outcomes of laparoscopic appendectomy (LA) will be similar to open appendectomy (OA) in children of all ages. DESIGN Retrospective cohort study using discharge abstract data. SETTING Twelve regional hospitals in Southern California. PATIENTS Seven thousand six hundred fifty patients underwent appendectomy for acute appendicitis (LA = 3551, OA = 4099). INTERVENTION Laparoscopic appendectomy or OA. MAIN OUTCOME MEASURES Thirty-day morbidity (wound infection, abscess drainage, and readmission) and length of hospitalization. RESULTS Use of laparoscopy increased from 22% in 1998 to 70% in 2007. Overall, patients undergoing LA were older (mean [SD] age, 12.8 [3.2] vs 10.4 [3.7] years; P < .001) and had a lower perforation rate (24% vs 34%; P < .001). Multivariable logistic regression demonstrated a decreased odds ratio for wound infection (odds ratio, 0.6; 95% confidence interval, 0.5-0.8) and abscess drainage (odds ratio, 0.6; 95% confidence interval, 0.4-0.7) following LA compared with OA. Multivariable linear regression also showed decreased length of hospitalization following LA compared with OA. CONCLUSION Now the preferred operation for children with appendicitis, LA was associated with a decreased risk of wound infection, abscess drainage, and length of hospitalization compared with OA.