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Single vs Three Port Laparoscopic Appendectomy for Pediatric Acute Appendicitis
Max D. Hazeltine, Brittany Dacier, Michael P. Hirsh, Jeremy T. Aidlen, Muriel A. Cleary
Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, United States

Objective:
Evaluate patient outcomes and healthcare utilization after single port appendectomy as compared to three port appendectomy.

Design:
Single center retrospective cohort study.

Setting:
Tertiary care, academic medical center.

Patients:
Patients age <19 who were diagnosed with acute appendicitis and underwent appendectomy during the same hospitalization.

Interventions:
N/A

Main Outcome Measures:
Thirty-day readmission.

Results:
There were 815 patients in the single port group and 64 in the three port group. Age, sex, and race were distributed equally between groups. The single port group had a lower mean weight (47.1 vs 55.2 kg, p=0.045). Patients in the single port, as compared to the three port group, were less often found to have a perforated appendix (10.6% vs 39.1%, p=<0.001) or appendicolith intraoperatively (3.1% vs 9.4%, p=0.03), had a shorter mean length of stay (1.7 vs 3.9 days, p<0.001), were less frequently discharged on antibiotics (19.4% vs 53.1%, p<0.001), and had lower rates of thirty-day readmission (2.9% vs 10.9%, p=0.001) and additional emergency department or clinic visits (16.1% vs 31.3%, p=0.002). Multiple logistic regression found that being discharged on antibiotics had higher odds of thirty-day readmission (adjusted odds ratio 5.78, 95% confidence interval 2.08 - 16.06), even after adjusting for findings of intraoperative appendiceal perforation, length of stay, length of symptoms, white blood cell count, and surgical approach (single or three port).

Conclusions:
Single port appendectomy is a safe surgical option with patient selection favoring those with non-perforated appendicitis. Antibiotics upon discharge was the primary factor associated with thirty-day readmission regardless of surgical approach.


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