Pediatric laparoscopic appendectomy: a population-based study of trends, associations, and outcomes

PurposeWe performed a population-based study to analyze the trends, associations, and outcomes of laparoscopic appendectomy (LA) in the Canadian universal health care setting.MethodsChildren younger than 18 years coded for urgent appendectomy in the discharge abstract database of the Canadian Institute of Health Information during 2004–2010 were analyzed. The Cochran–Armitage test, logistic regression, and quintile regression were used to perform the necessary analyses.Results41,405 children were studied. LA incidence steadily increased from 28.8% to 66.4%, p < .0001. Conversion rates significantly decreased, while LA for perforated appendicitis significantly increased. LA occurred significantly less in younger patients [OR 0.24 (< 5 years), OR 0.45 (6–11 years)], males [OR 0.79], and operations by a general surgeon [OR 0.33]. Rural domicile, socioeconomic status, and hospital type had no effect. LA decreased hospital stay for simple appendicitis by one day beginning in 2006, and by variable durations for perforated appendicitis throughout the study period.ConclusionsThe incidence of LA in Canada has more than doubled. Older children, females, and patients treated by pediatric surgeons are more likely to receive LA, while domicile, socioeconomic status, and hospital type have no effect. LA reduced hospital stay for both simple and perforated appendicitis.