INTRODUCTION: The utility of incidental appendectomy (IA) or prophylactic appendectomy in the absence of appendicitis has been studied for many concomitant procedures. However, IA during cholecystectomy has not been evaluated in the pediatric population or using a propensity score–matched analysis (PSMA). This study sought to compare nationwide outcomes after cholecystectomy with IA in children. METHODS: Patients ≤18 years old who underwent cholecystectomy from 2010- to 2014 were identified from the Nationwide Readmissions Database. Characteristics were compared using standard statistical tests. PSMA with >30 covariates including demographics, comorbidities, postoperative complications, and hospitalization factors was performed between those receiving cholecystectomy (CCY) alone vs CCY with IA. RESULTS: A total of 34,390 patients underwent cholecystectomy during the study period with a median age of 15 (interquartile range 13 to 17) years old. Laparoscopic (92%) and open (6%) cholecystectomies were performed most frequently, with 2% requiring conversion to an open approach. PSMA demonstrated a longer length of stay and higher index admission cost in those receiving CCY alone, while all admission complications including wound infection rates were not significantly different (Table 1). No significant differences in readmissions within 30 (9% CCY vs 8% CCY with IA) or 365 days (4% CCY vs <2% CCY with IA) were detected. Those undergoing CCY alone had higher overall readmission costs ($11,783 [$4,942 to $39,836] vs $6,100 [$2,358 to $19,719] CCY with IA; p = 0.010). Table 1. - Propensity Score–Matched Analysis of Cholecystectomy vs Cholecystectomy with Incidental Appendectomy Characteristic Cholecystectomy n = 405 (50%) Cholecystectomy with incidental appendectomy n = 405 (50%) p Value Length of stay (median days [interquartile range]) 4 [2–9] 3 [2–5] <0.001 Index admission cost (median $USD [interquartile range]) $13,438 [$8,047–$23,100] $8,403 [$6,437–$12,727] <0.001 Complication Wound infection <1% <1% 1.00 Wound disruption <1% <1% 1.00 Sepsis/bacteremia <1% <1% 1.00 Pneumonia <2% <1% 0.546 Other infections <3% <2% 0.625 Nausea, vomiting, and diarrhea 6% 9% 0.085 CONCLUSION: This nationwide PSMA indicates that IA in pediatric cholecystectomies is not associated with higher postoperative complications, cost, or readmissions. This suggests that IA performed during cholecystectomy is safe, cost-effective, and worthy of future study.