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Evaluating the effect of time process measures on appendectomy clinical outcomes
Paulette I Abbas1, Michelle Peterson2, Lindsay J Stephens2
1Texas Children's Hospital, Baylor College of Medicine, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Journal of Pediatric Surgery
|March 16, 2016
Summary
Pre-operative delays in pediatric appendicitis did not increase complications. Disease severity, not timing, is the key predictor of postoperative complications and organ space surgical site infections.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Appendicitis Management
Background:
- Varied reports exist on the impact of time to appendectomy on clinical outcomes.
- This study investigates the effects of pre-operative delays in pediatric acute appendicitis.
Purpose of the Study:
- To determine if pre-operative delays impact postoperative complications (POC) and organ space surgical site infection (OSSI) in pediatric appendicitis.
- To identify predictors of POC and OSSI in this patient population.
Main Methods:
- Analysis of a prospective database of children with acute appendicitis (January 2013-June 2014).
- Univariate analyses compared time metrics, patient characteristics, and disease severity with POC and OSSI.
- Multivariate logistic regression identified predictors of POC and OSSI.
Main Results:
- Neither time from presentation to appendectomy nor diagnosis to appendectomy increased POCs.
- Operative time was longer in patients with POC and OSSI on univariate analysis.
- Disease severity was the most significant predictor of POC (OR 6.5) and OSSI (OR 76.6) after adjusting for confounding factors.
Conclusions:
- Pre-operative delays were not associated with increased postoperative complications or organ space surgical site infections.
- Disease severity is the strongest predictor of POC or OSSI in pediatric appendicitis.
- Operative time may serve as a surrogate for disease severity.
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