Risk factors for surgical difficulty in interval appendectomy for perforated appendicitis with abscess in children

Area of Science:

• Pediatric Surgery
• Surgical Outcomes
• Appendicitis Management

Background:

• Perforated appendicitis with abscess often requires interval appendectomy.
• Predicting surgical difficulty is crucial for patient management and resource allocation.

Purpose of the Study:

• To identify predictors of surgical difficulty during interval appendectomy for pediatric appendiceal abscess.
• To establish criteria for anticipating complex surgical cases.

Main Methods:

• Retrospective review of 61 children with appendiceal abscess undergoing interval appendectomy (2012-2024).
• Comparison of clinical data between uncomplicated and difficult surgeries (operative time > 2 hours or additional trocars).
• Multivariate and ROC analyses to identify risk factors and predictive cut-off values.

Main Results:

• Difficult surgery was associated with older age (11.5 vs. 8.8 years), greater height, higher weight, larger abscesses, and longer initial hospital stay.
• Multivariate analysis indicated older age, larger abscess diameter, and longer initial hospital stay as risk factors for surgical difficulty.
• ROC analysis suggested cut-off values: age 10.4 years, abscess diameter 5.8 cm, and hospital stay 16.5 days for predicting complicated appendectomy.

Conclusions:

• Older age, larger abscess size, and prolonged hospital stay prior to surgery are associated with increased surgical difficulty in interval appendectomy for appendiceal abscess.
• These factors can aid in preoperative risk assessment and surgical planning.