Association of Intraoperative Findings With Outcomes and Resource Use in Children With Complicated Appendicitis

Anandalwar, Seema P.; Cameron, Danielle B.; Graham, Dionne A.; Melvin, Patrice; Dunlap, Jonathan L.; Kashtan, Mark A.; Hall, Matthew; Saito, Jacqueline M.; Barnhart, Douglas C.; Kenney, Brian D.; Rangel, Shawn J.

doi:10.1001/jamasurg.2018.2085

Cited by 63 publications

(40 citation statements)

References 24 publications

(40 reference statements)

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“…Yet, surgery and perioperative care of children with appendicitis can be both challenging and expensive, and avoiding complications is of the highest priority. 5,[18][19][20] In line with earlier studies, 14,21 our data report a very low mortality and a low overall risk of complications, and we conclude that treatment in general was safe and effective in several aspects. However, since appendicitis is relatively common during childhood and adolescence, even low rates of complications lead to significant disease burden and costs beyond the index hospitalization.…”

Section: Discussionsupporting

confidence: 91%

“…[6][7][8][9] More severe appendicitis is associated with longer hospital stay, more surgical adverse events, and higher costs. 5 An increased risk of small bowel obstruction (SBO) has been reported in adults diagnosed with complicated as compared with uncomplicated appendicitis (1.5 vs. 0.5% risk during 10 years of follow-up, 10 and 2.8 vs. 0.7% during 30 years of follow-up 11 ). The few single-center studies on pediatric appendicitis that have been performed are in line with these results 12,13 ; however, comprehensive population-based analyses of the short-and long-term risks for adverse outcome in complicated and uncomplicated pediatric appendicitis are needed.…”

Section: Introductionmentioning

confidence: 99%

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A Nationwide Cohort Study of Outcome after Pediatric Appendicitis

et al. 2020

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Introduction Children with appendicitis often present with complicated disease. The aim of this study was to describe the clinical management of pediatric appendicitis, and to report how disease severity and operative modality are associated with short- and long-term risks of adverse outcome. Materials and Methods A nationwide retrospective cohort study of all Swedish children (<18 years) diagnosed with appendicitis, 2001 to 2014 (n = 38,939). Primary and secondary outcomes were length of stay, surgical site infections, readmissions, 30-day mortality, and long-term risk of surgery for small bowel obstruction (SBO). Implications of complicated disease and operative modality were assessed with adjustment for age, gender, and trends over time. Results Complicated appendicitis was associated with longer hospital stay (4 vs. 2 days, p < 0.001), increased risk of surgical site infection (5.9 vs. 2.3%, adjusted odds ratio [aOR]: 2.64 [95% confidence interval, CI: 2.18–3.18], p < 0.001), readmission (5.5 vs. 1.2, aOR: 4.74 [95% CI: 4.08–5.53], p < 0.001), as well as long-term risk of surgery for SBO (0.7 vs. 0.2%, adjusted hazard ratio [aHR]: 3.89 [95% CI: 2.61–5.78], p < 0.001). Intended laparoscopic approach was associated with reduced risk of surgical site infections (2.3 vs. 3.1%, aOR: 0.74 [95% CI: 0.62–0.89], p = 0.001), but no overall reduction in risk for SBO; however, successful laparoscopic appendectomy was associated with less SBO during follow-up compared with open appendectomy (aHR: 0.27 [95% CI: 0.11–0.63], p = 0.002). Conclusion Children treated for complicated appendicitis are at risk of substantial short- and long-term morbidities. Fewer surgical site infections were seen after intended laparoscopic appendectomy, compared with open appendectomy, also when converted procedures were accounted for.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

A Nationwide Cohort Study of Outcome after Pediatric Appendicitis

et al. 2020

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“… 2 , 3 , 4 Perforated appendicitis is associated with substantial morbidity, including abdominal abscess, small bowel obstruction, sepsis, bowel resection, longer hospital stays, increased encounters with health care, and higher cost. 5 , 6 , 7 , 8 Delayed diagnosis of appendicitis is also a top cause of malpractice claims in pediatrics. 9 …”

Section: Introductionmentioning

confidence: 99%

Clinical Features and Preventability of Delayed Diagnosis of Pediatric Appendicitis

et al. 2021

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IMPORTANCE Delayed diagnosis of appendicitis is associated with worse outcomes than timely diagnosis, but clinical features associated with diagnostic delay are uncertain, and the extent to which delays are preventable is unclear.OBJECTIVE To determine clinical features associated with delayed diagnosis of pediatric appendicitis, assess the frequency of preventable delay, and compare delay outcomes.

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“…This procedure type was selected for our analysis because they are expected to have minimal to no blood loss along with a minimal surgical stress response. Our cohort did indeed experience a lower complication rate than higher risk procedure types, such as appendectomy (13.6%) and ventriculoperitoneal shunt (13.5%) . However, our analysis allows clinical practitioners to tailor informed consent and preemptively manage those patients that are at high risk (eg, ASA classification of three or greater and nutritional deficiency).…”

Section: Discussionmentioning

confidence: 76%

Predictive factors for adverse outcomes in pediatric patients undergoing low‐risk skin and soft tissue surgery: A database analysis of 6730 patients

Cheon

Longhini

Lee

et al. 2018

Pediatric Anesthesia

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Summary Background There is a paucity of data regarding risk stratification of pediatric patients presenting for low‐risk skin and soft tissue surgery. Aims We sought to determine the incidence and independent predictors of postoperative complications and unplanned 30‐day readmission in a cohort of children undergoing low‐risk skin and soft tissue surgery. Methods The study included pediatric patients who underwent minor procedures of the skin and soft tissue at continuously enrolled American College of Surgeons National Surgical Quality Improvement Program Pediatric hospitals over a two‐year period. The primary outcome was a 30‐day postoperative complication composite. The secondary outcome was unplanned 30‐day readmission. Results The final analysis included 6,730 patients. There were a total of 170 postoperative complications among 152 patients (2.23%) with the majority of complications being either wound‐related or postoperative mechanical ventilation. The independent predictors for an increased risk of postoperative complication were American Society of Anesthesiologists classification ≥3 and nutritional deficiency. There were 41 unplanned readmissions (0.61%). The presence of a postoperative wound complication or a postoperative pulmonary complication during the index hospital stay was an independent risk factor for unplanned 30‐day readmission. Conclusion Pediatric patients with American Society of Anesthesiologists classification ≥3 and nutritional deficiency undergoing low‐risk surgery are at risk for the development of postoperative complications. Patients who develop wound and postoperative pulmonary complications are at higher risk for unplanned 30‐day readmission. Identification of these higher risk patients may allow the anesthesiologist to implement targeted therapies to minimize the likelihood of occurrence of these complications.

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Association of Intraoperative Findings With Outcomes and Resource Use in Children With Complicated Appendicitis

Cited by 63 publications

References 24 publications

A Nationwide Cohort Study of Outcome after Pediatric Appendicitis

A Nationwide Cohort Study of Outcome after Pediatric Appendicitis

Clinical Features and Preventability of Delayed Diagnosis of Pediatric Appendicitis

Predictive factors for adverse outcomes in pediatric patients undergoing low‐risk skin and soft tissue surgery: A database analysis of 6730 patients

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