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Nationwide management of perforated pediatric appendicitis: Interval versus same-admission appendectomy
Carlos Theodore Huerta1, Steve C Courel2, Walter A Ramsey1
1University of Miami Miller School of Medicine, Miami, FL, USA; DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Insights
Interval appendectomy for perforated appendicitis resulted in more procedures and higher costs, with similar complication rates compared to same-admission appendectomy in children. This impacts treatment decisions for pediatric perforated appendicitis.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Health Services Research
Background:
- Conservative management followed by interval appendectomy is a common approach for pediatric perforated appendicitis.
- Existing studies often lack national scope, being limited to single or non-competing institutions.
- Comparative national outcome data is needed to inform treatment strategies for perforated appendicitis in children.
Purpose of the Study:
- To compare national postoperative outcomes between interval appendectomy and same-admission appendectomy in pediatric patients with perforated appendicitis.
- To evaluate differences in complication rates, procedure types, length of stay, and costs between the two management strategies.
Main Methods:
- A retrospective comparative study using the Nationwide Readmission Database (2010-2014).
- Identified pediatric patients (<18 years) with perforated appendicitis undergoing appendectomy via ICD-9-CM codes.
- A propensity score-matched analysis (PSMA) compared outcomes for interval appendectomy versus same-admission appendectomy, controlling for 33 covariates.
Main Results:
- The study included 63,627 pediatric patients; 1% underwent interval appendectomy, 99% same-admission appendectomy.
- Interval appendectomy patients were more likely to have laparoscopic procedures (87% vs. 78%) but also higher conversion rates (5% vs. 3%).
- Same-admission appendectomy was associated with a higher rate of small bowel obstruction; interval appendectomy incurred higher combined hospitalization costs despite shorter index LOS.
Conclusions:
- Interval appendectomy in children with perforated appendicitis led to more concomitant procedures and increased overall hospitalization costs.
- Postoperative complication profiles were similar between interval and same-admission appendectomy groups.
- Findings suggest that while interval appendectomy may offer benefits like shorter index LOS, the increased costs and procedural burden warrant consideration.
Purpose:
Although conservative management followed by readmission for interval appendectomy is commonly used to manage perforated appendicitis, many studies are limited to individual or noncompeting pediatric hospitals. This study sought to compare national outcomes following interval or same-admission appendectomy in children with perforated appendicitis.
Methods:
The Nationwide Readmission Database was queried (2010-2014) for patients <18 years old with perforated appendicitis who underwent appendectomy using ICD9-CM Diagnosis codes. A propensity score-matched analysis (PSMA) utilizing 33 covariates between those with (Interval Appendectomy) and without a prior admission (Same-Admission Appendectomy) was performed to examine postoperative outcomes.
Results:
There were 63,627 pediatric patients with perforated appendicitis. 1014 (1%) had a prior admission for perforated appendicitis within one calendar year undergoing interval appendectomy compared to 62,613 (99%) Same-Admission appendectomy patients. The Interval Appendectomy group was more likely to receive a laparoscopic (87% vs. 78% same-admission) than open (13% vs. 22% same-admission; p < 0.001) operation. Patients receiving interval appendectomy were more likely to have their laparoscopic procedure converted to open (5% vs. 3%) and receive more concomitant procedures. PSMA demonstrated a higher rate of small bowel obstruction in those receiving Same-Admission appendectomy while all other complications were similar. Although those receiving Interval Appendectomy had a shorter index length of stay (LOS) and lower admission costs, they incurred an additional $8044 [$5341-$13,190] from their prior admission.
Conclusion:
Patients treated with interval appendectomy experienced more concomitant procedures and incurred higher combined hospitalization costs while still having a similar postoperative complication profile compared to those receiving same-admission appendectomy for perforated appendicitis.
Level Of Evidence:
III.
Type Of Study:
Retrospective Comparative Study.
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