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Appendectomy in the pediatric population—a German nationwide cohort analysis



Meta-analyses indicate advantages of laparoscopic compared to open appendectomy. Nationwide analyses on results of laparoscopic appendectomy are scarce and studies from Germany are not available. This observational cohort study based on a nationwide insurance database was performed to analyze results of pediatric laparoscopic versus open appendectomy in general use.


Data were extracted from the largest German statutory health insurance TK (∼9 million clients) in a 3-year period (2010–2012). All patients aged 4–17 years with International Classification of Procedures in Medicine (ICPM) code “appendectomy” were included. Logistic regression analysis for the risk of a surgical complication within 180 postoperative days was performed.


Appendectomy was performed in 8110 patients (52.6 % male; 47.4 % female) and conducted laparoscopically in 75.0 % of the patients (conversion rate = 1.2 %). Laparoscopic compared to open surgery was associated with a shorter length of hospital stay in both uncomplicated and complicated appendicitis. Patients with complicated appendicitis had lower readmission rates for surgical complications after laparoscopic appendectomy and logistic regression analysis confirmed a significantly lower risk of readmission for surgical complications after laparoscopic compared to open operation in adolescents. Pediatric surgeons operated 23.9 % and general surgeons 76.1 % of patients. Laparoscopy was less frequently used and the conversion rate was significantly higher in pediatric surgical departments.


This first nationwide German cohort study confirms that laparoscopic appendectomy is associated with a less complicated postoperative course compared to open appendectomy, particularly in patients with complicated appendicitis. Pediatric surgeons used laparoscopy less frequently compared to general surgeons. Laparoscopic appendectomy should therefore be further promoted in pediatric surgical centers in Germany.

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Correspondence to Jan-Hendrik Gosemann.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplement Table 1

ICPM codes for reoperations after laparoscopic and open appendectomy. (JPG 101 kb)

Supplement Table 2

ICD10 codes for readmission after laparoscopic and open appendectomy. (JPG 121 kb)

Supplement Figure 1

Logistic regression analysis: adjusted prediction of the risk of a surgical complication after laparoscopic and open surgery for uncomplicated appendicitis (adjusted for gender, type of surgical department, time of surgery, and geographical region). (JPG 89 kb)

Supplement Figure 2

Logistic regression analysis: adjusted prediction of the risk of a complication during the initial stay after treatment in designated pediatric surgical centers and general surgical departments (adjusted for gender, severity of appendicitis, time of surgery, and geographical region). (JPG 92 kb)

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Gosemann, JH., Lange, A., Zeidler, J. et al. Appendectomy in the pediatric population—a German nationwide cohort analysis. Langenbecks Arch Surg 401, 651–659 (2016).

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  • Appendicitis
  • Laparoscopy
  • Open surgery
  • Complication
  • Children