Delayed Appendectomy in Pediatric Cancer Patients with Leukopenia is Associated with Worsened Outcomes

Acute appendicitis in leukopenic pediatric cancer patients is a clinical challenge. While the perceived risks of surgery in this population may delay immediate appendectomy, we sought to identify the consequences of delaying surgery based on the severity of leukopenia at diagnosis. We hypothesized that leukopenic cancer patients are more likely to experience delayed appendectomy and that delay would be associated with worsened outcomes.

Using ACS NSQIP-P data from 2016-2023, we identified pediatric oncology patients who underwent appendectomy for acute appendicitis. Leukopenic patients (< 4,000 WBC/μL) were stratified by preoperative WBC count as: < 1,000, 1,000-<2,500, and 2,500-<4,000 WBC/μL. Delayed appendectomy was defined as surgery 24 hours or more from admission. The primary outcome was the prevalence of complicated appendicitis. Bivariate comparisons were made using chi-square and nonparametric tests, with p<0.05 considered significant.

Of 310 pediatric cancer patients, 84 (27.1%) experienced delayed appendectomy. Median time to operation was significantly longer for leukopenic patients (22.7 hours vs. 11.8 hours, p<0.001). Patients with leukopenia with delayed appendectomy were more likely to have complicated appendicitis (29.2% vs. 2.0%, p<0.001); this association was not observed in non-leukopenic patients. Within each stratum of leukopenic patients, delayed appendectomy was associated with significantly longer length of stay.

Leukopenic pediatric oncology patients experienced longer delays to appendectomy for acute appendicitis than non-leukopenic patients. Among leukopenic patients, delaying appendectomy by over 24 hours was associated with an increased proportion of complicated appendicitis and prolonged hospitalization, supporting early operative management regardless of leukopenia severity.