Disease severity and postoperative complications after appendectomy

Appendectomy is among the most common emergency operations performed in children and is generally well tolerated. However, postoperative complications remain an important source of morbidity, particularly in patients with complicated appendicitis. Disease severity is a major predictor of adverse postoperative outcomes. Despite this, there is no universal definition for complicated appendicitis. American College of Surgeons' National Surgical Quality Improvement Program in Pediatrics (NSQIP-P) criteria provide a proposed intraoperative framework for severity stratification that may help to improve reporting and comparison of outcomes. The most clinically relevant postoperative complications after pediatric appendectomy include organ-space infection or intra-abdominal abscess, surgical site infection, postoperative ileus, small bowel obstruction, and rare technical complications such as stump leak. Their incidence, presentation, and management vary based on appendicitis severity, operative findings, and postoperative care pathways. Current evidence suggests that severity-based postoperative care, avoidance of unnecessary drain placement, selective imaging, early transition to oral antibiotics when appropriate, and standardized recovery protocols may reduce variation in management and improve outcomes. This review summarizes the most common postoperative complications following pediatric appendectomy, with emphasis on severity stratification, prevention, recognitions, and contemporary management strategies.