Population-Based Intraoperative Disease Severity Criteria for Pediatric Appendicitis

Area of Science:

• Pediatric Surgery
• Surgical Quality Improvement
• Healthcare Outcomes Research

Background:

• A standardized approach is needed to assess appendicitis severity in children for accurate outcome prediction and comparative performance reporting.
• The National Surgical Quality Improvement Program (NSQIP) Pediatric offers intraoperative criteria for complicated appendicitis.

Purpose of the Study:

• To investigate the association between NSQIP Pediatric intraoperative criteria for complicated appendicitis and patient outcomes.
• To determine if the number of these criteria correlates with adverse events and resource utilization.

Main Methods:

• A cohort study utilizing the NSQIP Pediatric Appendectomy Procedure Targeted and General Participant Use Data Files.
• Inclusion of children under 18 who underwent appendectomy between 2019 and 2022 at 148 NSQIP Pediatric participating hospitals.
• Multivariable regression analysis adjusted for patient characteristics to assess the impact of intraoperative criteria on outcomes.

Main Results:

• Of 82,950 patients, 27.9% had at least one criterion for complicated appendicitis.
• Each criterion (visible perforation, abscess, fecalith, exudate) was independently associated with higher rates of adverse events.
• An increasing number of criteria demonstrated a stepwise increase in the risk of adverse events and resource use.

Conclusions:

• The presence and number of NSQIP Pediatric criteria for complicated appendicitis are significantly associated with postoperative complications and increased resource use.
• These criteria represent a robust, evidence-based framework for severity assessment in pediatric appendicitis.
• Adoption of these criteria can improve risk stratification and hospital performance evaluations.