Prophylactic intraabdominal drains do not confer benefit in pediatric perforated appendicitis: Results from a quality...

Area of Science:

• Pediatric Surgery
• Surgical Quality Improvement
• Infectious Disease Prevention

Background:

• Prophylactic intraabdominal drains are utilized to prevent intraabdominal abscess (IAA) following perforated appendicitis.
• The efficacy of routine drain placement in pediatric cases remains a subject of investigation.

Purpose of the Study:

• To evaluate the impact of a quality improvement initiative involving prophylactic intraabdominal drain placement on IAA rates in pediatric perforated appendicitis.
• To determine if routine drain placement reduces the incidence of intraabdominal abscess in children.

Main Methods:

• A 27-month quality improvement initiative involving intraoperative closed-suction drain placement in pediatric patients (<18 years) with perforated appendicitis.
• Comparison of IAA rates between patients who received drains during the initiative and a control group from the preceding and subsequent periods.
• Primary outcome was the 30-day IAA rate, analyzed using univariate and multivariate methods.

Main Results:

• The quality improvement initiative included 270 patients, compared to 109 controls. IAA occurred in 20.0% of initiative patients versus 22.9% of controls (p=0.52).
• Multivariate analysis did not associate the initiative with reduced odds of IAA (OR 0.83, 95% CI 0.48-1.44).
• Median length of stay was longer in the initiative group during the index admission and over 30 postoperative days, though these differences did not persist after adjustment.

Conclusions:

• The quality improvement initiative implementing prophylactic intraabdominal drains did not decrease the intraabdominal abscess rate in pediatric perforated appendicitis.
• Routine prophylactic intraabdominal drain placement is not recommended for pediatric perforated appendicitis based on these findings.