Preoperative Predictors of Prolonged Hospital Stay after Appendectomy in Children: A Prospective Cohort Study

To identify preoperative predictive factors of prolonged hospital stay following appendectomy in children.

A prospective cohort study was carried out in a tertiary pediatric surgical referral center in Tunisia between January 2022 and December 2025. All consecutive children younger than 14 y who underwent appendectomy during the study period were eligible for inclusion.

During the study period, 653 pediatric patients underwent appendectomy, including 132 patients (20.2%) with prolonged hospital stay. The mean age was 9.5 ± 2.7 y, and 436 patients (66.8%) were male. Six variables emerged as independent predictive factors of prolonged hospital stay following appendectomy. These included age less than 6 y, duration of symptoms greater than 48 h, pre-hospital antibiotic use, Sun's Pediatric Comorbidity Index ≥3, Alvarado score ≥7, and CRP >90 mg/L. Among these predictors, elevated CRP demonstrated the strongest association with prolonged hospital stay.

Several simple and readily available preoperative factors were independently associated with prolonged hospital stay following appendectomy in children. Early recognition of these factors may support improved perioperative planning, optimized resource allocation, and more accurate communication with caregivers.