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Abscess and symptoms duration upon presentation should guide decision algorithms for early versus interval

Faidah Badru1, Nicholas Piening2, Armando Salim Munoz Abraham1

  • 1Saint Louis University, United States; SSM Health Cardinal Glennon Children's Hospital, United States.

Pediatrics and Neonatology
|February 10, 2019
PubMed

Insights

Early appendectomy for complicated appendicitis in children may reduce length of stay and complications, especially for those with small abscesses and short symptom duration. This approach optimizes resource use and patient outcomes.

Area of Science:

  • Pediatric Surgery
  • Surgical Outcomes Research

Background:

  • Complicated appendicitis in children presents a significant clinical challenge.
  • Treatment strategies range from immediate (early) to delayed (interval) appendectomy.
  • Optimal timing for appendectomy in complicated cases remains under investigation.

Purpose of the Study:

  • To compare outcomes between early appendectomy (EA) and interval appendectomy (IA) for complicated appendicitis in pediatric patients.
  • To identify specific patient subgroups who may benefit most from early appendectomy.

Main Methods:

  • Retrospective review of 316 pediatric patients with complicated appendicitis (2010-2015).
  • Patients categorized into early appendectomy (EA) and interval appendectomy (IA) groups.
  • Statistical analysis included Pearson's Chi square and Student's T test.

Main Results:

  • The IA group exhibited longer symptom duration, increased leukocytosis, higher rates of initial abscess, more overall complications, and prolonged length of stay (LOS).
  • Subgroup analysis revealed that patients with small abscesses (≤3 cm) and short symptom duration (≤5 days) still experienced prolonged LOS and increased complications with IA compared to EA.
  • EA group (53%) versus IA group (47%) demographics were analyzed.

Conclusions:

  • A significant portion of pediatric complicated appendicitis cases involve small abscesses and short symptom duration.
  • Early appendectomy may lead to decreased LOS, reduced resource utilization, and fewer complications for this specific patient subset.
  • These findings suggest that early appendectomy is a potentially beneficial strategy for select pediatric patients with complicated appendicitis.
Abstract

Keywords:
abscessappendicitisearlyinterval

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