Paediatric negative appendicectomy rates at a regional Western Australian Centre: a five‐year cohort study

Abstract

BackgroundIn acute appendicitis, decision‐making around operative intervention for paediatric patients differs from adults due to a higher weight placed on clinical assessment and reduced rates of cross‐sectional imaging. In regional settings, non‐paediatric emergency doctors, general surgeons, and radiologists usually assess and manage this patient group. Differences have been observed in paediatric negative appendicectomy rates between general and paediatric centres.MethodsA retrospective cohort study was performed, identifying paediatric patients undergoing emergency appendicectomy at the Southwest Health Campus (Bunbury, Western Australia) from 2017 to 2021. The primary outcome measure was histopathology confirming the absence of transmural inflammation of the appendix. In addition, clinical, biochemical and radiological data were collected to identify predictors of negative appendicectomy (NA). Secondary outcome measures were hospital length‐of‐stay and post‐operative complication rates.ResultsFour hundred and twenty‐one patients were identified, of which 44.9% had a negative appendicectomy. Statistically significant associations between female gender, white cell count less than 10 × 109, neutrophil ratio less than 75%, low CRP and NA were observed. NA was not associated with a lower risk of re‐admission or complications compared with appendicectomy for appendicitis.ConclusionsOur centre's NA rate is higher than that observed in the literature at both non‐paediatric and paediatric surgical centres. NA has similar morbidity risk to appendicectomy for uncomplicated appendicitis and offers a timely reminder that diagnostic laparoscopy in children is not benign.

Evaluation of geographic variations in appendicectomy outcomes within Western Australia assessing the impact of surgical wait times and rate of negative appendicectomies in both urban and rural locations statewide

“…A recent audit conducted to examine pediatric negative appendicectomy rates at Southwest Health Campus Bunbury including 421 patients found the negative appendicectomy rate to be higher than observed in previous literature at 45.58%. The authors noted this was concerning since diagnostic laparoscopy in children is not benign, with negative appendicectomy having a similar morbidity risk to appendicectomy for uncomplicated appendicitis [ 7 ].…”

Changes in Levels of Serum Cytokines and Chemokines in Perforated Appendicitis in Children

“…Negative appendectomies are also not without risks. The risk of re-admission or complications in children with negative appendectomies is comparable to that in children with appendicectomies for confirmed appendicitis [ 8 ]. These risks may be potentially avoided with better diagnostic tools, higher risk identification, and more accurate treatment advice.…”