Comparison of pediatric laparoscopic appendectomy outcomes between teaching and nonteaching hospitals: a multi-institutional study

Abstract

Purpose: With heightened emphasis on patient safety, it is important to document the effect of residents acting as the surgeon. This study compares the outcomes of laparoscopic appendectomy (LA) in children between teaching and nonteaching institutions.

Methods: A retrospective review of all patients <18 years undergoing LA for appendicitis over a 10-year period was performed. The outcomes from 2 teaching institutions were compared with 10 nonteaching institutions. Study outcomes included postoperative morbidity (wound infection, abscess drainage, and readmission) and length of hospitalization (LOH).

Results: Five hundred forty-two patients were treated at the teaching institution (mean age = 11 years, 62% male) and 3012 at the nonteaching institution (mean age = 13 years, 60% male). The perforated appendicitis rate was 33% at the teaching institution and 22% at the nonteaching institution (P < 0.0001). In patients with nonperforated appendicitis, rates of wound infection, abscess drainage, and readmission were similar between the institutions. However, for perforated appendicitis, rates of wound infection, abscess drainage, and readmission were all lower at the teaching institutions. LOH was longer at the teaching institutions for both nonperforated and perforated appendicitis.

Conclusions: The morbidity for LA was significantly lower in children with perforated appendicitis at the teaching institutions, whereas morbidity for nonperforated appendicitis was similar. LOH was longer in the teaching institutions. Overall, the presence of surgical trainees had minimal adverse impact on the outcomes of LA in children with appendicitis.