Missing data handling in pediatric appendectomy research: current practices and National Surgical Quality Improvement...

Area of Science:

• Pediatric Surgery
• Surgical Outcomes Research
• Biostatistics

Background:

• Appendectomy is a common pediatric surgical procedure.
• The influence of missing data handling on clinical conclusions in pediatric surgery is understudied.
• Current reporting practices for missing data in pediatric appendectomy literature are largely unknown.

Purpose of the Study:

• To assess current reporting practices of missing data in pediatric appendectomy literature.
• To quantify the impact of different missing data handling strategies on identifying postoperative infectious complication risk factors.

Main Methods:

• Systematic review of pediatric appendectomy literature from 2023 (PubMed, Web of Science).
• Retrospective analysis of 142,129 cases from the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2015-2022).
• Comparison of five missing data strategies: available case analysis, threshold-based exclusion, complete case analysis, simple imputation, and multiple imputation.

Main Results:

• 54.3% of reviewed articles failed to mention missing data; 86.4% used complete case analysis.
• 39.3% of NSQIP-P records had missing values (height, race most common).
• Missing data handling significantly altered the significance of risk factors (e.g., preoperative white blood cell count); complete case analysis was most conservative.

Conclusions:

• Methodological transparency regarding missing data is insufficient in pediatric surgical research.
• The choice of data handling strategy critically impacts the identification of clinical risk factors.
• Prioritize multiple imputation and mandate rigorous reporting of missingness to ensure evidence-based surgical guidelines.