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Laparoscopy uptake for paediatric appendicectomy: a comparison of general surgeons versus specialist paediatric surgeons in England from 1997 to 2015

Laparoscopy uptake for paediatric appendicectomy: a comparison of general surgeons versus specialist paediatric surgeons in England from 1997 to 2015
Laparoscopy uptake for paediatric appendicectomy: a comparison of general surgeons versus specialist paediatric surgeons in England from 1997 to 2015

Introduction: laparoscopy is used in as many as 95% of adult appendicectomies. There is level I evidence showing that it reduces wound infection, postoperative ileus and length of inpatient stay in children compared with the open approach. The aim of this study was to report the uptake of laparoscopy for paediatric appendicectomy in England and to determine whether this was similar for general surgeons (GS) and specialist paediatric surgeons (SPS). 

Methods: Hospital Episode Statistics data were obtained for all children aged <16 years who had an OPCS 4.6 code for emergency appendicectomy from 1997 to 2015 (18 years). Data are analysed to compare rate of laparoscopic vs open procedures for GS and SPS over time and to investigate factors associated with the use of laparoscopy. 

Results: there were 196,987 appendicectomies and where specialty was available, 133,709 (79%) cases were undertaken by GS and 35,141 (21%) by SPS. The rate of cases undertaken with laparoscopy for both specialties combined increased from 0.8% in 1998 to 50% in 2014 (p<0.0001). In 2014, this rate was 41% for GS compared with 71% for SPS (p<0.0001). Female gender (odds ratio (OR)=1.84, 95% confidence interval (CI) 1.80-1.90), increasing age (OR=1.18, 95% CI 1.18-1.19 per year) and treatment by SPS (OR=3.71, 95% CI 3.60-3.82) were all factors positively associated with use of laparoscopy in multivariate analysis. 

Conclusions: there has been a vast increase in the proportion of appendicectomies undertaken laparoscopically in children. Despite adjusting for patient factors, laparoscopy was used significantly less by GS when compared with SPS. This difference is most apparent in younger children.

Appendicitis, Laparoscopy, Outcomes, Paediatric surgery
0035-8843
538-542
Bethell, G.S.
c7a62cc1-5573-41f6-ae00-3c11e8219dd4
Adams, S.
db62dde7-c0da-44cc-a3a8-1f4a4eb116b4
Johnson, T.
1c3ef99a-c67b-4482-ba75-8efa73222878
Hall, N. J.
6919e8af-3890-42c1-98a7-c110791957cf
Stanton, M.P.
0f6a6113-57d0-4c8a-b518-cd9aea3dc998
Bethell, G.S.
c7a62cc1-5573-41f6-ae00-3c11e8219dd4
Adams, S.
db62dde7-c0da-44cc-a3a8-1f4a4eb116b4
Johnson, T.
1c3ef99a-c67b-4482-ba75-8efa73222878
Hall, N. J.
6919e8af-3890-42c1-98a7-c110791957cf
Stanton, M.P.
0f6a6113-57d0-4c8a-b518-cd9aea3dc998

Bethell, G.S., Adams, S., Johnson, T., Hall, N. J. and Stanton, M.P. (2021) Laparoscopy uptake for paediatric appendicectomy: a comparison of general surgeons versus specialist paediatric surgeons in England from 1997 to 2015. Annals of The Royal College of Surgeons of England, 104 (7), 538-542. (doi:10.1308/rcsann.2021.0232).

Record type: Article

Abstract

Introduction: laparoscopy is used in as many as 95% of adult appendicectomies. There is level I evidence showing that it reduces wound infection, postoperative ileus and length of inpatient stay in children compared with the open approach. The aim of this study was to report the uptake of laparoscopy for paediatric appendicectomy in England and to determine whether this was similar for general surgeons (GS) and specialist paediatric surgeons (SPS). 

Methods: Hospital Episode Statistics data were obtained for all children aged <16 years who had an OPCS 4.6 code for emergency appendicectomy from 1997 to 2015 (18 years). Data are analysed to compare rate of laparoscopic vs open procedures for GS and SPS over time and to investigate factors associated with the use of laparoscopy. 

Results: there were 196,987 appendicectomies and where specialty was available, 133,709 (79%) cases were undertaken by GS and 35,141 (21%) by SPS. The rate of cases undertaken with laparoscopy for both specialties combined increased from 0.8% in 1998 to 50% in 2014 (p<0.0001). In 2014, this rate was 41% for GS compared with 71% for SPS (p<0.0001). Female gender (odds ratio (OR)=1.84, 95% confidence interval (CI) 1.80-1.90), increasing age (OR=1.18, 95% CI 1.18-1.19 per year) and treatment by SPS (OR=3.71, 95% CI 3.60-3.82) were all factors positively associated with use of laparoscopy in multivariate analysis. 

Conclusions: there has been a vast increase in the proportion of appendicectomies undertaken laparoscopically in children. Despite adjusting for patient factors, laparoscopy was used significantly less by GS when compared with SPS. This difference is most apparent in younger children.

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More information

e-pub ahead of print date: 25 November 2021
Keywords: Appendicitis, Laparoscopy, Outcomes, Paediatric surgery

Identifiers

Local EPrints ID: 473111
URI: http://eprints.soton.ac.uk/id/eprint/473111
ISSN: 0035-8843
PURE UUID: a3c77cae-93c7-438d-80de-2eda95981011
ORCID for G.S. Bethell: ORCID iD orcid.org/0000-0002-1302-0735
ORCID for N. J. Hall: ORCID iD orcid.org/0000-0001-8570-9374

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Date deposited: 10 Jan 2023 18:13
Last modified: 17 Mar 2024 04:17

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Contributors

Author: G.S. Bethell ORCID iD
Author: S. Adams
Author: T. Johnson
Author: N. J. Hall ORCID iD
Author: M.P. Stanton

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