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Appendicitis-related acute referrals to Children's Health Ireland from Non-Specialist Paediatric Surgical Centres
Zakya Penny1, Sami Abd Elwahab2, Brendan O'Connor2
1Department of General Paediatric Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland. zakyapenny21@rcsi.com.
Insights
Most pediatric appendectomies occur at general hospitals, with some children transferred to specialized centers for advanced care. This study analyzes appendicitis referrals to a children's hospital, highlighting the need for collaboration between general and specialist pediatric surgical centers.
Area of Science:
- Pediatric Surgery
- Surgical Emergencies
- Appendicitis Management
Background:
- Acute appendicitis is the most frequent surgical emergency in children.
- Most pediatric appendectomies are performed by adult general surgeons.
- Specialized pediatric surgical centers handle a smaller proportion of cases and receive transfers.
Purpose of the Study:
- To evaluate the frequency and characteristics of appendicitis-related patient transfers from non-specialist to a specialist pediatric surgical center.
- To understand the reasons for transfer and the patient demographics involved.
Main Methods:
- Retrospective review of appendicitis-related transfers to Children's Health Ireland (CHI) at Crumlin from January 2020 to December 2021.
- Data collected included reasons for transfer, referring hospital level, patient demographics, management strategies, surgical approach, length of stay, and imaging studies.
Main Results:
- Seventy-two children were transferred over two years, with a mean age of 9 years and a mean length of stay of 6 days.
- The majority (73%) were transferred from level 4 centers, with 97% transferred pre-operatively.
- Complicated appendicitis was confirmed in 37.5% of those with pre-operative imaging, and 92% ultimately underwent appendectomy.
Conclusions:
- While most pediatric appendectomies are performed at non-specialist centers, these facilities play a crucial role.
- Maintaining strong working relationships between general and specialist pediatric surgical centers is essential for optimal care of complex pediatric appendicitis cases.
Background:
Acute appendicitis is the most common surgical emergency in children. Eighty percent of paediatric appendicectomies are performed by adult general surgeons on an annual basis. The remaining 20% are performed at Children's Health Ireland (CHI) centres. Occasionally patients are transferred from Non-Specialist Paediatric Surgical Centres (NSPSC) for specialised pre-operative or post-operative care.
Aim:
To assess the rates of and characterise appendicitis-related referrals to CHI at Crumlin from NSPSC.
Methods:
A retrospective review of all appendicitis-related transfers to CHI at Crumlin between January 2020 and December 2021 was performed. Data relating to indications for transfer, referring hospital level, patient demographics, management, type of surgery, length of stay (LOS), and radiological studies were collected and analysed.
Results:
Seventy-two patients were transferred to CHI at Crumlin over the 2-year period. A total of 60.9% were male, mean age 9 ± 4.3 years, mean LOS 6.0 ± 2.2 days (range 1-30 days). Nineteen percent were under 5 years of age. Seventy-three percent were transferred from level 4 centres. Ninety-seven percent were transferred pre-operatively, 25% of those transferred pre-operatively had imaging in CHI confirming appendicitis. Fifty-five percent (40/72) of patients had pre-operative imaging performed. A total of 37.5% (15/40) confirmed complicated appendicitis. Twenty percent (8/40) underwent both ultrasound and computerised tomography (CT) at the referring centre. A total of 2.7% (2/72) were transferred with known co-morbidities. Ninety-two percent (66/72) underwent appendicectomy. Eight percent (6/72) were managed non-operatively (NOM) - 2 failed NOM, 2 underwent interval appendicectomy. Of those managed operatively, 76% (50/66) underwent laparoscopic appendicectomy, and 24% (16/66) were performed open.
Conclusion:
The majority of paediatric appendicectomies are performed at Non-Specialist Paediatric Surgical Centres. It is vital to maintain this working relationship so that specialist paediatric centres are available to provide care to complex paediatric patients.
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