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Development and Implications of an Evidence-based and Public Health-relevant Definition of Complicated Appendicitis

Danielle B Cameron1, Seema P Anandalwar1, Dionne A Graham2

  • 1Department of Surgery, Boston Children's Hospital-Harvard Medical School, Boston, MA.

Annals of Surgery
|October 12, 2018
PubMed

Insights

Four intraoperative findings in children with appendicitis, including visible hole, exudate, abscess, and fecalith, are linked to worse outcomes and increased healthcare costs. This study offers a framework for defining complicated appendicitis.

Area of Science:

  • Pediatric Surgery
  • Surgical Outcomes Research
  • Public Health

Background:

  • A lack of consensus exists regarding the definition of complicated appendicitis in children.
  • A standardized definition is crucial for consistent clinical research reporting and refining reimbursement policies.

Purpose of the Study:

  • To define complicated appendicitis in children based on intraoperative findings.
  • To investigate the impact of specific intraoperative findings on complication rates and resource utilization.

Main Methods:

  • Retrospective cohort study of 5002 pediatric appendectomy patients (ages 3-18) across 22 children's hospitals.
  • Data merged from the National Surgical Quality Improvement Program-Pediatric Appendectomy Pilot Database and Pediatric Health Information System Database.
  • Multivariable regression analysis to assess the association of four intraoperative findings (visible hole, diffuse exudate, abscess, fecalith) with outcomes and resource utilization.

Main Results:

  • Over 26% of cases exhibited at least one of the four defined intraoperative findings.
  • Each of the four findings independently correlated with significantly higher rates of adverse events and revisits.
  • All four findings were also independently associated with increased length of stay and hospital costs.

Conclusions:

  • Visible hole, diffuse exudate, abscess, and fecalith are key indicators of complicated appendicitis in children.
  • These findings provide an evidence-based framework for defining complicated appendicitis, impacting clinical practice and public health.
  • The study highlights the significant association between specific intraoperative findings, patient outcomes, and healthcare resource utilization.
Abstract

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