A state wide evaluation of appendectomy in children

BACKGROUND: Traditional management of appendicitis in children involves ope n appendectomy (OA), an operation that is relatively inexpensive and carrie s few risks and complications. However, little information is available reg arding the use, cost, and complication of laparoscopic appendectomy (LA) in children. METHODS: Our initial aim was to determine if LA is frequently performed in children (<15 years). We then compared the surgical results of OA versus LA . In conjunction with the Missouri Department of Health, we evaluated 793 c hildren treated for appendicitis throughout the state between January 1997 and June 1997, The authors were blinded to the patient, surgeon, and hospit al; no children were excluded. RESULTS: LA was infrequently performed in children with advanced disease. O verall, children undergoing LA were older and had a shorter hospitalization but no difference in hospital charge. When separated by child age, LA was associated with a shorter length of stay in all groups (0 to 5, 6 to 10, an d 11 to 15 years) but only children in the 6 to 10 year range had a lower h ospital charge when compared with patients undergoing OA. CONCLUSIONS: LA is becoming a common surgical approach for older children w ith simple appendicitis. Furthermore, these data suggest that LA, independe nt of individual surgeon or medical center, is associated with a decreased length of hospitalization without a significant difference in hospital char ge. Am J Surg. 1999;178:537-540. (C) 1999 by Excerpta Medica, Inc.