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Children with appendectomy have increased risk of future sepsis: Real-world data in Taiwan
Tzu-Han Liao1,2, Cheng-Li Lin3,4, Chien-Heng Lin5
1Division of Pediatric Gastroenterology, Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan.
Insights
Children who undergo appendectomy face a significantly higher risk of developing sepsis later in life. This study highlights the increased sepsis hazard in children post-appendectomy, emphasizing the need for further investigation into the underlying mechanisms.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Epidemiology
Background:
- Appendectomy is a common surgical procedure globally.
- Sepsis poses a significant threat to child health, causing substantial morbidity and mortality.
- Previous adult studies indicated a link between appendectomy and increased sepsis risk, but this relationship in children was unexplored.
Purpose of the Study:
- To investigate the association between appendectomy and the subsequent risk of sepsis in pediatric populations.
- To determine if children who have had an appendectomy are at a higher risk of developing sepsis compared to their peers.
Main Methods:
- A nationwide, population-based cohort study was conducted using Taiwan's National Health Insurance Research Database.
- 57,261 children under 18 who underwent appendectomy were matched 1:1 with 57,261 controls who did not.
- Propensity score matching controlled for age, sex, urbanization, and parental occupation. Multiple Cox regression and stratified analyses assessed the adjusted hazard ratio (aHR) for sepsis.
Main Results:
- Children who had an appendectomy exhibited a 2.38-fold increased risk of developing sepsis (aHR: 2.38; 95% CI: 1.98–2.87).
- This elevated risk was observed across all age groups: <6 years (aHR: 2.98), 7–12 years (aHR: 2.45), and 13–18 years (aHR: 2.18).
- Sepsis risk was notably higher with shorter follow-up periods, particularly within the first year post-appendectomy (aHR: 4.53), and remained elevated at 1–4 years (aHR: 2.19) and ≥5 years (aHR: 1.94).
Conclusions:
- Appendectomy is significantly correlated with an increased future risk of sepsis in children.
- The heightened risk of sepsis following appendectomy is consistent across all pediatric age demographics.
- Further research is essential to elucidate the biological mechanisms underlying the association between appendectomy and sepsis in children.
Background:
Appendectomy is one of the most commonly performed surgeries worldwide. Sepsis is a major aetiology of morbidity and mortality in children. Our preliminary research revealed a positive correlation amongst appendectomy and future risk of sepsis in adults. However, to date, the relationship between appendectomy and future risk of sepsis in children remains unknown. The aim of this research was to investigate the relationship between appendectomy and the hazard of future sepsis in children.
Methods:
We applied a nationwide population-based cohort to assess whether children who received appendectomy were at increased risk of subsequent sepsis. Overall, 57 261 subjects aged below 18 undergoing appendectomy as appendectomy group and 57 261 matched controls were identified as a non-appendectomy group from the National Health Insurance Research Database in Taiwan. We use propensity score analysis to match the age, sex, urbanisation level and parental occupation at the ratio to 1:1. Multiple Cox regression and stratified analyses were used to appraise the adjusted hazard ratio (aHR) for developing sepsis in children.
Results:
Children who received appendectomy had a 2.38 times higher risk (aHR: 2.38; 95% confidence interval [CI] = 1.98, 2.87) of developing sepsis than those who did not, and the risk was higher in all age groups (aHR: 2.98, 95% CI = 1.84, 4.83; aHR: 2.45, 95% CI = 1.08, 2.05; aHR: 2.18, 95% CI = 1.70, 2.80 in children aged <6, 7-12 and 13-18 years, respectively). Patients with <1-year follow-up showed a 4.53-fold risk of sepsis in the appendectomy cohort (aHR: 4.53, 95% CI = 2.80, 7.35). Patients with 1-4 and ≥5 years' follow-up showed a 2.19- and 1.94-times risk of sepsis (aHR: 2.19, 95% CI = 1.61, 2.97; aHR: 1.94, 95% CI = 1.48, 2.56 in 1-4 and >5 years, respectively).
Conclusion:
Appendectomy was correlative to a 2.38-fold increased future sepsis risk in children, and the risk in all age groups was higher. More studies to interpret the possible biological mechanisms of the associations amongst sepsis and appendectomy are warranted.
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