Minimizing unnecessary parenteral nutrition after appendectomy in children

Consensus guidelines have indicated that postoperative parenteral nutrition (PN) might provide benefit when patients are expected to be nil per os (NPO) ≥7 d and when PN is administered ≥5 d. We hypothesized that most children receiving PN after appendectomy do not satisfy these criteria.

The medical records of the patients who had undergone appendectomy for perforated appendicitis from 2006-2011 were analyzed, and the proportion meeting the criteria for beneficial PN was determined. The clinical parameters independently associated with the criteria for beneficial PN (PN therapy ≥5 d, ileus ≥5 d, NPO ≥7 d) were identified using multiple regression analysis.

A total of 1612 patients were treated for appendicitis. Of these, 587 met the inclusion criteria (age <16 y, perforated appendicitis, appendectomy within 24 h, no previous indication for PN). Of the 587 patients, 12.1% received PN; 43.8% of these received PN for ≥5 d. The predictors of PN duration of ≥5 d included preoperative symptoms for ≥3 d (P < 0.01) and initiation of PN by postoperative day 3 (P = 0.047). Preoperative symptoms for ≥3 d, imaging showing a discrete abscess or bowel obstruction, and operative findings of diffuse peritonitis predicted ileus of ≥5 d and NPO of ≥7 d (P < 0.01 for all). Major complications were more common in patients with ileus lasting ≥5 d.

Fewer than one-half of patients receiving PN in the present cohort met the consensus-based guidelines for postoperative PN. The preoperative symptom duration, preoperative imaging findings demonstrating abscess and/or bowel obstruction, and intraoperative findings of diffuse peritonitis might predict prolonged ileus and longer recovery periods for children undergoing surgery for perforated appendicitis.