Optimal Timing of Postoperative Imaging for Complicated Appendicitis

Area of Science:

• Pediatric Surgery
• Abdominal Imaging
• Healthcare Management

Background:

• Postoperative abscesses complicate roughly 25% of pediatric complicated appendicitis cases.
• These abscesses necessitate further interventions and prolong hospital stays (LOS).
• Optimal timing for postoperative imaging to detect abscesses remains undetermined.

Purpose of the Study:

• To evaluate the impact of postoperative imaging timing on outcomes in children with complicated appendicitis.
• To identify variations in imaging practices across different hospitals.

Main Methods:

• Retrospective review of the Pediatric Health Information System database (2013-2014).
• Inclusion criteria: children undergoing laparoscopic appendectomy with postoperative LOS of 5 days or more.
• Analysis of demographics, imaging details, drainage procedures, LOS, and 30-day readmission rates using chi-squared analysis.

Main Results:

• 3332 children met inclusion criteria from 21,985 laparoscopic appendectomies.
• 1174 (35.2%) patients received postoperative imaging (38.4% ultrasound, 75.0% CT scan).
• Imaging on postoperative day (POD) 5 versus POD 7 was linked to shorter LOS but lower intervention rates, increased repeat imaging, and higher readmission rates (P<.05).

Conclusions:

• Postoperative imaging timing for complicated appendicitis varies significantly among institutions.
• Earlier imaging (POD 5) correlated with decreased LOS but also higher readmission and repeat imaging rates.
• Delaying imaging until at least POD 6 may optimize diagnostic yield while minimizing radiation exposure and readmissions; further prospective studies are recommended.