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):39-44. doi: 10.3238/arztebl.m2023.0234.
Appendectomy 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.
We 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.
Of 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.
Among 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.
儿童阑尾切除术可通过腹腔镜（LA）或开放性手术（OA）进行。我们研究了手术技术以及 LA 转为 OA 对内窥镜治疗结果的影响。
我们分析了德国 AOK 法定健康保险公司承保的三个年龄组（1-5 岁、6-12 岁和 13-17 岁）的儿童和青少年患者的常规数据，这些患者在 2017-2019 年期间接受了阑尾切除术。使用相关指标评估 90 天内的一般手术并发症和再次手术。使用逻辑回归研究手术技术与这些指标之间的关联。
在纳入研究的 21541 名患者中，总体上有 2.1%的患者发生一般手术并发症，1.8%的患者需要再次手术。按年龄组细分，相应的数字为 5.4%和 4.4%（1-5 岁）、2.5%和 1.8%（6-12 岁）以及 1.5%和 1.6%（13-17 岁）。并发症和再次手术的主要危险因素是急性复杂阑尾炎和从 LA 转为 OA。回归分析显示，1-5 岁年龄组中，OA 与 LA 的结果相似（一般手术并发症的比值比和 95%置信区间：1.1[0.6；2.1]和再次手术的比值比和 95%置信区间：1.5[0.8；2.7]），但在其他两个年龄组中，OA 的结果更差（6-12 岁：1.9[1.2；2.9]和 2.1[1.5；2.9]；13-17 岁：1.7[1.0；2.9]和 2.2[1.4；3.6]）。当将转换归入 LA 组时，在所有年龄组中，患有急性单纯性阑尾炎的患者行 OA 与 LA 相比的再次手术比值比为 3.5[2.8；4.4]，患有复杂性阑尾炎的患者为 4.2[3.4；5.3]。复杂性阑尾炎还增加了一般手术并发症的发生率和住院时间。
在两个年龄较大的年龄组中，LA 引起的一般手术并发症和再次手术少于 OA。当将转换视为 LA 组的一部分时，这些差异则不太明显。1-5 岁的儿童似乎从腹腔镜技术中获益最少。
