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Operative Time Is Independently Associated With Morbidity in Pediatric Complicated Appendicitis
Nicholas J Iglesias1, Robert Arrowood2, Lori Montgomery2
1School of Medicine, University of Texas Medical Branch, Galveston, Texas.
Insights
Prolonged operative time (OT) in pediatric complicated appendicitis increases the risk of surgical site infections, drain placement, and readmissions. Optimizing OT is crucial for reducing patient morbidity.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Appendicitis Management
Background:
- Complicated appendicitis is a significant cause of morbidity in children.
- Previous studies identified obesity and disease severity as risk factors for surgical complications, but operative time (OT) was not extensively analyzed.
- Operative time (OT) is a potential, yet understudied, factor influencing outcomes in pediatric complicated appendicitis.
Purpose of the Study:
- To investigate the independent association between operative time (OT) and postoperative morbidity in children undergoing laparoscopic appendectomy for complicated appendicitis.
- To determine if prolonged OT correlates with increased rates of surgical site infections, hospital length of stay, readmissions, and need for interventional drainage.
Main Methods:
- Data were retrospectively collected from the 2018-2019 National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) datasets.
- Patients aged 2-18 years who underwent laparoscopic appendectomy for complicated appendicitis were included.
- Logistic and linear regression analyses were used to assess the association between OT and various morbidity outcomes, including surgical site infections (SSIs), length of stay (LOS), readmissions, and interventional radiologic drain (IR-drain) placement.
Main Results:
- A total of 8168 pediatric patients were analyzed.
- Each one-minute increase in operative time (OT) was independently associated with a higher likelihood of any surgical site infection (SSI), superficial SSI, organ-space SSI, interventional radiologic drain (IR-drain) placement, and 30-day readmission.
- The mean operative time was 55.8 minutes, with a mean hospital length of stay of 5.15 days.
Conclusions:
- Prolonged operative time (OT) is an independent risk factor for increased morbidity in pediatric complicated appendicitis.
- Specific morbidities associated with longer OT include surgical site infections, need for IR-drain placement, readmissions, and longer hospital LOS.
- Further research is needed to identify modifiable factors contributing to prolonged OT to optimize surgical procedures and reduce patient morbidity.
Introduction:
Complicated appendicitis is a common cause of morbidity in children. Studies have analyzed the risk factors in the surgical treatment of this pathology, including obesity and disease severity, but not operative time (OT). We hypothesize that OT is independently associated with increased morbidity for children with complicated appendicitis.
Methods:
Data were extracted from the 2018 and 2019 National Surgical Quality Improvement Program-Pediatrics data sets. Patients aged 2-18 y who underwent laparoscopic appendectomy for complicated appendicitis were identified. Patient demographics, disease severity, and operative details were evaluated. Surgical site infections (SSIs), hospital length of stay (LOS), ≤30-d readmissions and reoperations, interventional radiologic drain (IR-drain) placement, pneumonia, and death were analyzed. Logistic and linear regression analyses were performed.
Results:
A total of 8168 patients were analyzed, with a mean age of 9.96 ± 3.9 y and a mean weight of 41.2 ± 21.2 kg. The mean OT was 55.8 ± 24.9 min, with a mean LOS of 5.15 ± 3.37 d. For every 1-min increase in OT, there was an independently associated increase in the likelihood of any SSI (odds ratio [OR] = 1.01; 95% confidence interval [CI] 1.008-1.013), superficial SSI (OR = 1.01; 95% CI 1.004-1.020), organ-space SSI (OR = 1.01; 95% CI 1.008-1.013), IR-drain placement (OR = 1.01; 95% CI 1.008-1.013), and readmission (OR = 1.004; 95% CI 1.000-1.007).
Conclusions:
Prolonged OT is independently associated with greater likelihood of any SSI, superficial SSI, organ-space SSI, IR-drain placement, readmission and reoperation within 30 d, and longer hospital LOS. There is a need to determine modifiable factors that prolong OT to aid in the optimization of routine operations to reduce patient morbidity.
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