• Udo Rolle, Wolf O Bechstein, Claus Fahlenbrach, Günther Heller, Hans-Joachim Meyer, Ekkehard Schuler, Albrecht Stier, Beate Waibel, Elke Jeschke, Christian Günster, and Matthias Maneck.
• Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt/Main, Frankfurt/Main, Germany; Department of General, Visceral, Transplantation and Thoracic Surgery, University Hospital Frankfurt/Main, Frankfurt/Main, Germany; AOK Federal Association, Berlin, Germany; Institute for Quality Assurance and Transparency in Healthcare (IQTIG), Berlin, Germany; German Society of Surgery (DGCH), Berlin, Germany; Helios Kliniken, Division of Quality Management, Berlin, Germany; Department of General and Visceral Surgery, HELIOS Hospital Erfurt, Erfurt, Germany; Medical Service of the Health Insurance Fund Baden-Württemberg, Freiburg, Germany; AOK Research Institute (WIdO), Berlin, Germany.
• Dtsch Arztebl Int. 2024 Jan 26; 121 (2): 394439-44.

BackgroundAppendectomy in children is performed either lapa - roscopically (LA) or by open surgery (OA). We studied whether, and how, the outcome is affected by the technique used and by the intraoperative conversion of LA to OA.MethodsWe analyzed routine data from children and adolescents in three age groups (1-5 years, 6-12 years, and 13-17 years) who were insured by the AOK statutory health insurance carrier in Germany and who underwent appendectomy in the period 2017-2019. General surgical complications and reoperations within 90 days were assessed with relevant indicators. Associations between the surgical technique and these indicators were studied with logistic regression.ResultsOf the 21 541 patients included in the study, general surgical complications were observed in 2.1% and reoperations in 1.8% overall. Broken down by age group, the corresponding figures were 5.4% and 4.4% (age 1 to 5), 2.5% and 1.8% (age 6 to 12), and 1.5% and 1.6% (age 13 to 17). The main risk factors for complications and reoperations were acute complicated appendicitis and conversion from LA to OA. Regression analysis revealed similar outcomes with OA compared to LA in the 1-to-5 age group, (odds ratios and 95% confidence intervals: 1.1 [0.6; 2.1] for general surgical complications and 1.5 [0.8; 2.7] for reoperations), but worse outcomes with OA in the other two age groups (age 6 to 12: 1.9 [1.2; 2.9] and 2.1 [1.5; 2.9]; age 13 to 17: 1.7 [1.0; 2.9] and 2.2 [1.4; 3.6]). When conversions were assigned to the LA group, the odds ratio (OA compared to LA) for reoperation across all age groups was 3.5 [2.8; 4.4] in patients with acute uncomplicated appendicitis and 4.2 [3.4; 5.3] in patients with complicated appendicitis. Complicated appendicitis also increased the rate of general surgical complications and the length of stay in hospital.ConclusionAmong children in the two older age groups, LA was followed by fewer general surgical complications and reoperations than OA. These differences were less pronounced when conversions were counted as belonging to the LA group. Children aged 1-5 appear to benefit the least from the lapa - roscopic technique.

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