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When to take it out? Optimal timing of interval appendectomy in 500 consecutive children
Bethany J Farr1, Denston E Carey2, David P Mooney3
1Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
Insights
Performing interval appendectomy before 12 weeks after perforated appendicitis may increase the risk of acute inflammation, leading to longer operative times. This finding is crucial for optimizing surgical timing after nonoperative management.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Outcomes Research
Background:
- Interval appendectomy is a delayed surgical procedure after nonoperative management of perforated appendicitis.
- The optimal timing for interval appendectomy remains unclear, impacting patient care and surgical planning.
Purpose of the Study:
- To determine the optimal time interval between presentation of perforated appendicitis and subsequent interval appendectomy.
- To investigate the association between the timing of interval appendectomy and pathological findings, specifically acute inflammation.
Main Methods:
- A retrospective review of 500 patients who underwent interval appendectomy between 2006 and 2019 at a children's hospital.
- Data analysis included demographics, hospitalization details, and pathology reports, utilizing t-tests and logistic regression.
Main Results:
- Operations performed before 12 weeks post-presentation were associated with a two-fold increased odds of acute inflammation (p < 0.01).
- Acute inflammation correlated with significantly longer operative times (mean 101 vs. 84 minutes, p < 0.01).
- Factors like appendicolith presence, hospitalization length, drain placement, readmission, age, and gender did not predict acute inflammation.
Conclusions:
- Acute inflammation can persist for many weeks after appendicitis perforation and is linked to increased operative time.
- Performing interval appendectomy earlier than 12 weeks increases the likelihood of encountering acute inflammation.
Purpose:
While interval appendectomy following nonoperative management of perforated appendicitis is delayed until several weeks after presentation, the optimal time from presentation to interval appendectomy is unknown.
Methods:
The data warehouse of a large children's hospital was queried for interval appendectomies from 2006 to 2019. Data extracted included demographics, initial and operative hospitalization details, and pathology findings. Student's t-test and logistic regression were used where appropriate.
Results:
500 patients were identified with a mean age of 10 years, 53% male. Mean time to operation was 12.7 weeks. Operation prior to 12 weeks was associated with increased odds of acute inflammation on pathology (OR = 2, p < 0.01). Acute inflammation was associated with increased mean operative time (101 vs 84 min, p < 0.01). Presence of an appendicolith, initial hospitalization length, drain placement, readmission prior to operation, age and gender were all non-predictive of acute inflammation. Only 11% of appendices had an occluded lumen and 17% an appendicolith. Carcinoid tumors were identified in 6 patients (1.2%).
Conclusion:
Acute inflammation is found many weeks after perforation and is associated with increased operative time. Acute inflammation is more likely to be present in operations performed prior to 12 weeks.
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