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Postoperative timing of computed tomography scans for abscess in pediatric appendicitis
Jason W Nielsen1, Kelli J Kurtovic2, Brian D Kenney1
1Department of Surgery, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
Insights
Delaying postoperative imaging for complex appendicitis until postoperative day 7 reduces interventions without impacting patient outcomes. Most patients admitted by postoperative day 5 resolve symptoms without further procedures.
Area of Science:
- Pediatric Surgery
- Abdominal Imaging
- Appendicitis Management
Background:
- A significant proportion of pediatric appendicitis cases involve rupture, leading to postoperative intra-abdominal abscesses in 3%-25% of patients.
- The optimal timing for postoperative imaging to detect abscess formation remains a debated topic in clinical practice.
Purpose of the Study:
- To evaluate the impact of early versus delayed postoperative computed tomography (CT) scanning on the management of complex appendicitis.
- To determine if delaying imaging affects outcomes such as drainage procedures, length of stay, and readmission rates.
Main Methods:
- A retrospective study identified 195 pediatric patients with complex appendicitis not discharged before postoperative day (POD) 5.
- Patients were divided into two groups: early CT scan (before POD 7) and delayed CT scan (after POD 7).
- Subgroup analysis was performed on the delayed group based on fever status at POD 5.
Main Results:
- Early CT scans (before POD 7) led to significantly more drainage procedures (73.1%) and recurrent CT scans compared to delayed scans (28.6%).
- There were no significant differences in length of stay or readmission rates due to abscesses between early and delayed imaging groups.
- A majority of patients (76.9%) in the delayed imaging group resolved symptoms without intervention, with a low readmission rate (5.9%).
Conclusions:
- Postponing CT scans until POD 7 for complex appendicitis patients admitted by POD 5 resulted in fewer interventions and repeat scans.
- Delayed imaging did not increase length of stay or readmission rates for intra-abdominal abscesses.
- Most patients managed conservatively showed symptom resolution, suggesting a watchful waiting approach is effective.
Background:
One-quarter to one half of pediatric appendicitis patients present with ruptured appendicitis and about 3%-25% go on to form postoperative intra-abdominal abscesses. The optimal timing of postoperative imaging for suspected abscess formation has been a subject of debate.
Methods:
All patients who underwent appendectomy for complex appendicitis and were not discharged before postoperative day (POD) #5 from April 2012-October 2014 were identified. Patients were stratified into groups for comparison as follows: group 1 had postoperative computed tomography (CT) scans before POD#7 (n = 26) and group 2 did not (n = 169). Group 2 was further divided into those who were afebrile (group 2a, n = 106) or febrile (group 2b, n = 63) at POD#5.
Results:
A total of 195 patients met criteria. Early use of CT scans resulted in more drainage procedures (group 1, 73.1% versus group 2b, 28.6%, P < 0.001) and a higher recurrent CT scan rate (38.5% versus 9.5%). The groups had equivalent lengths of stay (11.9 versus 9.8 d, P = 0.10) and readmission rates due to abscesses (19.2% group 1 versus 6.3%, group 2b, P = 0.12) with no septic events. In total, 130 of the 169 patients (76.9%) in group 2 had resolution of symptoms before discharge without intervention with readmission for abscess in only 5.9%.
Conclusions:
Waiting until POD#7 before scanning led to fewer drainage procedures and recurrent CT scans without increasing length of stay or readmission rates. Most complex appendicitis patients still admitted at POD#5 had resolution of symptoms without need for intervention.
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