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Risk factors of postoperative adhesive bowel obstruction in children with complicated appendicitis
Wei Feng1, Xiao-Bing Du2, Xu-Feng Zhao1
1Graduate School, Tianjin Medical University, Tianjin, 300070, China.
Insights
Postoperative adhesive bowel obstruction (ABO) is a risk after appendectomy for complicated appendicitis in children. A new scoring model effectively predicts ABO and guides treatment decisions.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Complications
Background:
- Postoperative adhesive bowel obstruction (ABO) is a significant complication following appendectomy, particularly in cases of complicated appendicitis in children.
- Identifying risk factors and developing predictive tools are crucial for managing this condition.
Purpose of the Study:
- To analyze risk factors associated with postoperative ABO in children who underwent appendectomy for complicated appendicitis.
- To establish a predictive scoring model for postoperative ABO and inform treatment strategies for obstruction relief.
Main Methods:
- Retrospective review of pediatric patients who underwent appendectomy for complicated appendicitis between December 2014 and January 2020.
- Univariate and multivariate analyses were employed to identify independent risk factors for ABO.
- A scoring model was developed and validated for predicting postoperative ABO and the need for surgical relief.
Main Results:
- Of 780 patients, 11.2% developed ABO, with 27 requiring surgical intervention.
- Independent risk factors identified include age ≤ 6 years, overweight/obesity, symptom duration ≥ 36 hours, C-reactive protein ≥ 99 mg/L, operation duration ≥ 60 minutes, intraoperative peritoneal lavage, and postoperative flatus time ≥ 20 hours.
- The predictive model demonstrated high discrimination for ABO (AUC: 0.937) and surgical relief (AUC: 0.917).
Conclusions:
- Risk factors for postoperative ABO in children with complicated appendicitis require careful consideration.
- The developed scoring model offers a promising and novel approach for predicting postoperative ABO and aiding clinical decision-making for obstruction management.
Purpose:
Postoperative adhesive bowel obstruction (ABO) is a common complication especially in complicated appendicitis. This study aimed to analyze the risk factors for ABO following appendectomy in children with complicated appendicitis, and establish a scoring model for predicting postoperative ABO and treatment option to relieve the obstruction.
Methods:
From December 2014 to January 2020, all files of consecutive patients with complicated appendicitis underwent appendectomy were reviewed. Univariate and multivariate analyses were used to screen out the risk factors of postoperative ABO, and establish a scoring model for predicting postoperative ABO and surgical relief to relieve the obstruction.
Results:
Of the 780 patients, 87 (11.2%) had ABO following appendectomy, including 27 who underwent surgical relief. Age ≤ 6 years, overweight and obesity, duration of symptoms ≥ 36 h, C-reactive protein ≥ 99 mg/L, duration of operation ≥ 60 min, intraoperative peritoneal lavage, and postoperative flatus time ≥ 20 h were independent risk factors for postoperative ABO. The final scoring model for postoperative ABO included factors above, and exhibited a high degree of discrimination (area under the curve [AUC]: 0.937; 95% confidence interval [CI] 0.913-0.960) corresponding to an optimal cut-off value of 6: 82.8% sensitivity, 92.6% specificity. Furthermore, the scoring model showed a sensitivity of 74.1% and a specificity of 91.7% for patients wo underwent surgical relief to relieve obstruction with the optimal cut-off value of 9.
Conclusion:
Risk factors for postoperative ABO should be taken seriously in children with complicated appendicitis. The scoring model is a novel but promising method to predict postoperative ABO and provide reference for clinical decision-making to relieve the obstruction.
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