Prophylactic Drain Placement in Childhood Perforated Appendicitis: Does Spillage Matter?

Area of Science:

• Pediatric Surgery
• Surgical Outcomes
• Infectious Disease

Background:

• Prophylactic abdominal drains for perforated appendicitis in children have historically shown inferior results.
• Despite past findings, drains are still commonly used in pediatric surgery for perforated appendicitis, particularly with gross spillage.
• This study questions the utility of prophylactic drains even when significant intra-abdominal spillage is present.

Purpose of the Study:

• To evaluate the efficacy of prophylactic abdominal drains in children with perforated appendicitis, considering intraoperative spillage.
• To determine if drain placement impacts the rates of intra-abdominal abscess, wound infection, or bowel obstruction.
• To assess the association between drain placement and length of hospital stay.

Main Methods:

• Retrospective analysis of pediatric patients (<18 years) who underwent appendectomy for perforated appendicitis from July 2013 to March 2020.
• Patients were stratified based on the amount of intraoperative spillage.
• Demographic, laboratory, operative, and postoperative outcome data were analyzed.

Main Results:

• No significant differences in intra-abdominal abscess, wound infection, or bowel obstruction rates were observed between groups, irrespective of spillage.
• Children who received prophylactic drains had a significantly longer hospital stay (p = 0.0041).
• Drain placement was not associated with improved outcomes in perforated appendicitis, even with gross spillage.

Conclusions:

• Prophylactic abdominal drain placement offers no discernible benefit for perforated appendicitis in children, even in cases of gross spillage.
• Drain placement in this cohort was linked to an increased length of hospital stay.
• These findings suggest a reconsideration of routine drain use in this patient population.