Abdominal Drainage at Appendectomy for Complicated Appendicitis in Children: A Propensity-matched Comparative Study

Area of Science:

• Pediatric Surgery
• Surgical Outcomes
• Infectious Complications

Background:

• Abdominal drain placement after appendectomy is debated for complicated appendicitis.
• The effectiveness of drains in preventing postoperative complications remains unclear.

Purpose of the Study:

• To investigate the impact of abdominal drainage during appendectomy for complicated appendicitis in children.
• To determine if drain placement reduces or increases postoperative complications.

Main Methods:

• Retrospective analysis of 1762 pediatric appendectomies for complicated appendicitis from Japan's National Clinical Database (2015).
• One-to-two propensity score matching compared outcomes between drained and undrained groups.
• Subgroup analyses included perforated appendicitis, appendicitis with abscess, and open/laparoscopic approaches.

Main Results:

• Drainage was associated with a significant increase in wound dehiscence (0.3% vs 2.4%, P=0.001) and longer hospital stays (7 vs 9 days, P<0.001).
• No significant differences were found in overall complications, organ space surgical site infections, re-admission, or reoperation rates.
• Subgroup analyses confirmed drains did not reduce complications but were linked to longer hospital stays.

Conclusions:

• Abdominal drain placement in pediatric appendectomy for complicated appendicitis offers no advantage in preventing complications.
• Drainage may increase the risk of wound dehiscence and prolong hospital stays.
• Current evidence suggests avoiding routine drain placement in these pediatric cases.