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Pediatric appendicitis: Is referral to a regional pediatric center necessary?
Maggie M Hodges1, Clay Cothren Burlew, Shannon N Acker
1From the Laboratory for Fetal and Regenerative Biology, Department of Surgery (M.M.H.), University of Colorado Denver, Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of General Surgery (M.M.H., C.C.B., E.E.M., B.B.), Denver Health Medical Center, Denver, Colorado; Department of Pediatric Surgery (S.N.A., L.R.S.H., D.A.P., D.B.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado; Department of Emergency Medicine (G.E.S.), Denver Health Medical Center, Denver, Colorado; and University of Colorado School of Medicine (A.S.), Aurora, Colorado.
Insights
Children undergoing appendectomy for acute appendicitis have similar outcomes regardless of surgeon type. Pediatric surgeons and adult trauma/acute care surgeons provide equivalent care for pediatric appendectomies, optimizing resource allocation.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Healthcare Management
Background:
- Acute appendicitis is a common pediatric surgical emergency in the US, with over 80,000 cases annually.
- Appendectomies are performed by both pediatric and adult trauma/acute care surgeons.
- This study investigates if surgeon specialty impacts appendectomy outcomes in children.
Purpose of the Study:
- To compare appendectomy outcomes in children treated by pediatric surgeons versus adult trauma and acute care (TACS) surgeons.
- To evaluate differences in complication rates, operative time, and length of stay.
- To inform resource allocation for pediatric appendicitis care.
Main Methods:
- Retrospective chart review of 6- to 18-year-old patients undergoing appendectomy.
- Comparison between a children's hospital (CHCO) and an urban safety-net hospital (DHMC).
- Subgroup analysis at DHMC comparing pediatric surgeons and TACS surgeons.
Main Results:
- No significant differences in perforated appendicitis, operative time, or complication rates between CHCO and DHMC TACS groups.
- Shorter length of stay observed in the DHMC TACS group compared to CHCO.
- Postoperative infectious complications and 30-day readmission rates were equivalent across groups.
Conclusions:
- Pediatric appendectomy outcomes are comparable between pediatric and adult TACS surgeons for children over 5 years old.
- Length of stay, infectious complications, and readmission risks do not differ based on surgeon specialty.
- Transferring children to pediatric surgeons may not be necessary, allowing for better resource distribution.
Background:
Acute appendicitis is the most common emergent surgical procedure performed among children in the United States, with an incidence exceeding 80,000 cases per year. Appendectomies are often performed by both pediatric surgeons and adult general/trauma and acute care (TACS) surgeons. We hypothesized that children undergoing appendectomy for acute appendicitis have equivalent outcomes whether a pediatric surgeon or a TACS surgeon performs the operation.
Methods:
A retrospective chart review was performed for patients 6 to 18 years of age, who underwent appendectomy at either a regional children's hospital (Children's Hospital of Colorado [CHCO], n = 241) or an urban safety-net hospital (n = 347) between July 2010 and June 2015. The population of patients operated on at the urban safety-net hospital was further subdivided into those operated on by pediatric surgeons (Denver Health Medical Center [DHMC] pediatric surgeons, n = 68) and those operated on by adult TACS surgeons (DHMC TACS, n = 279). Baseline characteristics and operative outcomes were compared between these patient populations utilizing one-way analysis of variance and χ test for independence.
Results:
When comparing the CHCO and DHMC TACS groups, there were no differences in the proportion of patients with perforated appendicitis, operative time, rate of operative complications, rate of postoperative infectious complications, or rate of 30-day readmission. Length of stay was significantly shorter for the DHMC TACS group than that for the CHCO group.
Conclusions:
Our data demonstrate that among children older than 5 years undergoing appendectomy, length of stay, risk of infectious complications, and risk of readmission do not differ regardless of whether they are operated on by pediatric surgeons or adult TACS surgeons, suggesting resources currently consumed by transferring children to hospitals with access to pediatric surgeons could be allocated elsewhere.
Level Of Evidence:
Therapeutic/Care management, level III.
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