Pediatric Emergency Appendectomy and 30-Day Postoperative Outcomes in District General Hospitals and Specialist Pediatric Surgical Centers in England, April 2001 to March 2012: Retrospective Cohort Study (original) (raw)
Related papers
Background: Appendicectomy for acute appendicitis in children may be performed in specialist centres by paediatric surgeons or in general surgery units. Service provision and outcome of appendicectomy in children may differ between such units. Methods: This multicentre observational study included all children (aged less than 16 years) who had an appendicectomy at either a paediatric surgery unit or general surgery unit. The primary outcome was normal appendicectomy rate (NAR). Secondary outcomes included 30-day adverse events, use of ultrasound imaging and laparoscopy, and consultant involvement in procedures. Results: Appendicectomies performed in 19 paediatric surgery units (242 children) and 54 general surgery units (461 children) were included. Children treated in paediatric surgery units were younger and more likely to have a preoperative ultrasound examination, a laparoscopic procedure, a consultant present at the procedure, and histologically advanced appendicitis than children treated in general surgery units. The unadjusted NAR was significantly lower in paediatric surgery units (odds ratio (OR) 0·37, 95 per cent confidence interval 0·23 to 0·59; P <0·001), and the difference persisted after adjusting for age, sex and use of preoperative ultrasound imaging (OR 0·34, 0·21 to 0·57; P <0·001). Female sex and preoperative ultrasonography, but not age, were significantly associated with normal appendicectomy in general surgery units but not in paediatric surgery units in this adjusted model. The unadjusted 30-day adverse event rate was higher in paediatric surgery units than in general surgery units (OR 1·90, 1·18 to 3·06; P =0·011). When adjusted for case mix and consultant presence at surgery, no statistically significant relationship between centre type and 30-day adverse event rate existed (OR 1·59, 0·93 to 2·73; P =0·091). Conclusion: The NAR in general surgery units was over twice that in paediatric surgery units. Despite a more severe case mix, paediatric surgery units had a similar 30-day adverse event rate to general surgery units. Service provision differs between paediatric and general surgery units.
Pediatric Surgery International, 2008
Background Laparoscopic appendicectomy is increasingly used in children. This national retrospective study compared outcomes of paediatric open and laparoscopic appendicectomy. Methods Length of stay, readmission rates and mortality in children undergoing open and laparoscopic appendicectomy in English NHS Trusts between 1 April 1996 and 31 March 2006 were compared. Procedures coded as emergency excision of appendix (OPCS-4 H01) on the Hospital Episode Statistics (HES) database in patients less than 15 years of age were included. Multivariate analysis was used to identify independent predictors of length of hospital stay and mortality.
Appendicectomy at a children's hospital: what has changed over a decade?
ANZ Journal of Surgery, 2012
Background: Appendicectomy remains the most common abdominal emergency procedure performed by surgeons. We reviewed appendicectomies for the calendar years 1999 and 2009 to assess any changes in the referral, presentation and management at a tertiary paediatric institution. Methods: We performed a retrospective chart review on all appendicectomies at our institution in 1999 and 2009. Patients were identified using the International Classification of Diseases 9 and 10 Australian Modification codes. A P-value of <0.05 was considered significant. Results: The number of emergency appendicectomies more than doubled from 126 to 296 between 1999 and 2009. The rate of laparoscopic appendicectomy increased from <1% in 1999 to 70.3% in 2009. Overall, the mean patient age increased from 8.6 years in 1999 to 9.68 in 2009 (P = 0.005). There was an increase in the proportion (19.8% versus 39.5%, P < 0.001) and age (5.3 versus 8.8, P < 0.0001) of patients referred via inter-hospital transfers between the two time periods. In 2009, laparoscopic surgery required on average 13.6 min longer than open surgery. This increase in surgical duration was offset by a decrease in the length of stay (5.0 Ϯ 0.7 versus 3.5 Ϯ 0.3, P < 0.0001). Conclusions: Our institution has experienced an extraordinary rise in the number of appendicectomies performed, which cannot be explained by an increase in the local paediatric population alone. There appears to have been dramatic shift in the surgical care of children to our tertiary paediatric centre. The majority of appendicectomies in 2009 were laparoscopic, with a reduced length of stay despite longer operative times.
Emergent vs urgent appendectomy in children: a study of outcomes
Journal of Pediatric Surgery, 2005
Background: Emergent appendectomy (EA) in children is still considered surgical dogma and continues to be recommended as a standard of care. This study examined whether emergent operation has any outcome advantages over urgent operation. Methods: The charts of children treated for appendicitis during a recent 28-month period at 2 children's hospitals, where appendectomies are not performed between midnight and 7 am, were reviewed. Outcomes were compared between patients who underwent EA (within 8 hours of presentation) vs those who underwent urgent appendectomy (UA, after 8 hours). Results: Three hundred sixty-five children met the criteria for the study. One hundred sixty-one (44%) were in the EA group (5.3 F 2.1 hours), and 204 (56%) were in the UA group (16.8 F 9.7 hours). The incidence of gangrenous or perforated appendicitis was significantly higher in the EA group (47% vs 36%, P = .04). There were no significant differences between EA and UA in postoperative outcomes, including readmissions (3.7% vs 1.0%, P = .08), wound infections (0.6% vs 2.4%, P = .17), or postoperative abscesses (1.9% vs 1.5%, P = .77). There were no significant differences in average hospital stay or average hospital charges between EA and UA (3.2 days for both, 14,775vs14,775 vs 14,775vs14,850), respectively. Conclusions: Emergent appendectomy in children has no advantages over UA with respect to gangrene and perforation rates, readmissions, postoperative complications, hospital stay, or hospital charges. Performance of a UA at a time convenient to the surgeon should be considered within the standard of care. D
Laparoscopic versus open appendicectomy in children: A UK District General Hospital experience
Journal of Pediatric Surgery, 2014
The aim of this study was to evaluate the potential role of laparoscopic appendicectomy in reducing morbidity and length of stay in children compared to open procedures in a UK District General Hospital setting. Methods: A three-year retrospective review of children ≤15 years with histologically confirmed appendicitis who underwent laparoscopic (LA) and/or open (OA) appendicectomy was performed. Choice of operation was based on individual surgeon's preference and on patient's body size. Data collected included rate of histologically complicated appendicitis, post-operative length of stay (LOS), and collective and differential morbidity rates, i.e., wound infection, intra-abdominal collection, and ileus. Chi-square and Mann-Whitney tests were used for statistical analysis. P b 0.05 was regarded as significant. Results: Eighty children (70% male) were identified at median age 11 (3-15) years. They could be divided into complicated (n = 18, 22%) and simple appendicitis (n = 62, 78%). Appendicectomy was performed in all as an OPEN (n = 53, 66%) or LAPAROSCOPIC (n = 27, 34%) procedure. Both groups were comparable in gender distribution (P = 0.11) and rate of complicated appendicitis (30% vs. 19%, respectively; P = 0.27). Median age was significantly lower in the OPEN group [10 (3-15) vs. 12 (7-15) years; P b 0.004]. Laparoscopic appendicectomy had a significantly lower rate of collective morbidity (3.8% vs. 25.9%; P b 0.003), including lower rate of intra-abdominal collection (1.9% vs. 14.8%; P b 0.01). Median LOS was not significantly different (1 day vs. 2 days; P = 0.14). Conclusion: Laparoscopic appendicectomy in children in a UK District General Hospital is safe and was associated with significantly less post-operative morbidity than the open technique.
Surgery Today, 2020
The purpose of this study was to investigate the outcomes after appendectomy in children according to hospital size. Methods The records of 11,565 patients with the diagnosis-related group code for appendectomy were extracted from HIRA-Pediatric Patient Sample from 2012 to 2016. The number of hospital visits and the length of stay in hospital within 30 days after appendectomy were analyzed. Results Patients who were treated at large-sized hospitals were more likely to be younger, more likely to reside in metropolitan areas, and tended to receive laparoscopic surgery. The number of hospital visits within 30 days in patients managed by medium-and large-sized hospitals decreased in comparison to small-sized hospitals. The length of hospital stay in large-sized hospitals was decreased in comparison to small-and medium-sized hospitals. A subgroup analysis revealed that complicated appendectomy did not have a significant impact on the difference in the length of hospital stay between hospital sizes. Conclusion The number of hospital visits and the length of hospital stay was higher in small-sized hospitals in comparison to large-sized hospitals. Appendectomy performed in the larger hospital showed better outcomes in pediatric patients. We recommend that pediatric surgical procedures be performed in large hospitals, and that proper incentives be given for procedures to be performed by pediatric specialists.
Outcome after introduction of laparoscopic appendectomy in children: A cohort study
Journal of Pediatric Surgery, 2016
Introduction: Acute appendicitis in children is common and the optimal treatment modality is still debated, even if recent data suggest that laparoscopic surgery may result in shorter postoperative length of stay without an increased number of complications. The aim of the study was to compare the outcome of open and laparoscopic appendectomies during a transition period. Materials and methods: This was a retrospective cohort study with prospectively collected data. All patients who underwent an operation for suspected appendicitis at the Astrid Lindgren Children's Hospital in Stockholm between 2006 and 2010 were included in the study. Results: 1745 children were included in this study, of whom 1010 had a laparoscopic intervention. There were no significant differences in the rate of postoperative abscesses, wound infections, readmissions or reoperations between the two groups. The median operating time was longer for laparoscopic appendectomy than for open appendectomy, 51 vs. 37 minutes (p b 0.05). The postoperative length of stay was similar in the two groups. A simple comparison between the groups suggested that laparoscopic appendectomy had a shorter median postoperative length of stay, 43 vs. 57 hours (p b 0.05). However, there was a trend in time for a shorter postoperative length of stay, and a trend for more of the procedures to be performed laparoscopically over time so on regression analysis, the apparent decrease in length of stay with laparoscopy could be ascribed to the general trend toward decreased length of stay over time, with no specific additional effect of laparoscopy. Conclusions: Our data show no difference in outcome between open and laparoscopic surgery for acute appendicitis in children in regard of complications. The initial assumption that the patients treated with laparoscopic surgery had a shorter postoperative stay was not confirmed with linear regression, which showed that the assumed difference was due only to a trend toward shorter postoperative length of stay over time, regardless of the surgical intervention.
Langenbeck's Archives of Surgery
Purpose In general, an appendectomy is presumed to have a limited burden of disease. However, in current literature, reported complication rates vary. This study aims to provide additional insights in the incidence of post-appendectomy complications in children with acute appendicitis. Methods This retrospective cohort study included children (0–17 years old) that underwent appendectomy at our tertiary referral centre for suspected acute appendicitis (January 2011–December 2018). Children referred to our centre, and those that underwent non-operative treatment were excluded. Post-appendectomy complications were recorded from electronic medical charts using predefined definitions and classified as severe (Clavien-Dindo III–IV) or less severe (Clavien-Dindo I–II). Results A total of 131 children were included. Simple and complex appendicitis was diagnosed in 66 (50%) and 60 (46%) children, respectively. A non-inflamed appendix was seen in five (4%) children. One or more complications ...
International Surgery Journal
Background: Acute appendicitis is one of the most common abdominal surgical condition in pediatric population. It accounts for 1-8% of children presenting in pediatric surgical emergency. The aim of this study was to evaluate pediatric appendectomy in our department.Methods: It was a hospital based prospective cohort study spanning over a period of 5 years, where all diagnosed cases of pediatric appendicitis were enrolled. Demographic profile, clinical features and operative findings were analyzed. Patients were kept on regular follow-up and complications were noted.Results: During the study period 146 patients were enrolled for the study. Male: female ratio was 1:1. Maximum patients belonged to age group of 11-15 years (42%). Pain in abdomen and fever were the most common presenting symptoms. Tenderness in right iliac fossa was the most common clinical sign (89.72%) and inflamed appendix was the most common operative finding in the study (83.91%).Conclusions: The diagnosis of acute...
Journal of Pediatric Surgery, 2010
Background/Purpose: Ongoing debate surrounds the future provision of general paediatric surgery. The aim of this study was to compare outcomes for childhood appendicitis managed in a district general hospital (DGH) and a regional paediatric surgical unit (RU). Methods: Data collected retrospectively for a 2-year period in a DGH were compared with data collected prospectively for 1 year in an RU, where appendicitis management is guided by a care pathway. Children aged 6 to 15 years were included. Results: Four hundred and two patients were included (DGH ,196; RU, 206). There were more cases of gangrenous/perforated appendicitis in the RU (P b .0001). In the DGH, fewer patients received preoperative antibiotics (P b .0001) or underwent preoperative pain scoring (P b .0001). When adjusted for case mix, the relative risk of complications for a child managed at the DGH was 1.76 (95% confidence interval, 1.44-2.16; P b .0001) and that of readmission was 1.76 (95% confidence interval, 1.43-2.16; P b .0001) when compared with the RU. Conclusions: Patients with appendicitis managed in the DGH had a higher risk of complications and readmission. However, this appears to be related to the use of a care pathway at the RU. Introduction of a care pathway in the DGH may improve outcomes and thus support the ongoing provision of general paediatric surgery.