Geographic influence on postoperative complications in children with complicated appendicitis: a single center study (original) (raw)
Related papers
2020
Background: Acute appendicitis (AA) is the inflammation of the vermicular appendage. It is one of the most common causes of abdominal pain and surgical abdominal emergencies in children. Nowadays, and according to literature, the method of treatment remains a dialectical subject. The long delay before admission to hospital is associated with increased rates of perforation. In this study, we evaluate how physicians in Lebanon act in front of acute appendicitis. Materials and Methods: Retrospective, observational, multicenter study on all pediatric patients who underwent appendectomy in three Lebanese hospitals: Nabih Berri Governmental University Hospital, Bahman Hospital and Rafic Hariri University Hospital during year 2017. Results: The study included 102 patients, mean age 10.7 years. Up to 48 Hours of delay, No correlation was found between delay in surgery and the risk of developing a complicated form of the disease such as perforation and peritonitis and postoperative complicat...
Dubai Medical Journal, 2021
Background: Appendicitis is one of the most common emergency conditions that occur in the pediatric population. The condition is usually suspected clinically, and the diagnosis is confirmed by radiological investigations such as ultrasound, CT scan, or MRI. This study was conducted to contribute to global databases by presenting data from the Middle East with an objective of identifying the clinical characteristics of children who were diagnosed with acute appendicitis and underwent laparoscopic appendectomy at a single pediatric surgery center in Dubai. Methods: A 2-year hospital-based retrospective cohort study was conducted at Mediclinic Parkview Hospital, Dubai, enrolling all patients younger than 14 years who were diagnosed with acute appendicitis and who underwent laparoscopic appendectomy. Demographic data, clinical presentation, laboratory, radiological and pathology findings, postoperative complications, and readmission rates were analyzed. Results: Fifty-six patients were ...
Journal of Pediatric Surgery, 1993
0 To determine whether the current "gatekeeper" controls on health care lead to an increase in treatment delay and morbidity of acute appendicitis in children, we reviewed the experience with this disease at a large children's hospital over a lo-year period. One hundred seven consecutive children 18 years and younger operated on for acute appendicitis from July 1.1988 to June 30, 1990 were compared with 119 children with the same diagnosis from July 1, 1978 to June 30,198O. Age, sex, race, antecedent illnesses, initial physician contact and diagnosis, time to referral and operation, pathology, morbidity, and length of stay were reviewed. The two groups were comparable in terms of age, sex, race, antecedent illnesses, and negative appendectomy rate. More patients in the recent group were initially seen in an emergency room or urgent care setting than in the previous group (82.2% Y 48.5%. P = .07). The accuracy of the initial diagnosis was significantly lower in the more recent group (P = .05). No change existed between the groups in the time to a physician; however, a significant (P = 64) difference existed in the time to surgeon (41.2 hours in the earlier group v 56.4 hours in the recent group). No significant difference existed between the groups in time from surgeon to operation. Although not statistically significant, the morbidity rate was increased in the recent group (13.3% Y 6.5%, P = .17). However, more complex morbidity occurred in the recent group, including 6 patients with 2 or more complications, and 2 deaths, compared with one patient with multiple complications and no deaths in the earlier group. Factors affecting the presence of complications include time to physician, time to surgeon, and pathology (multiple logistic regression). No significant difference existed in length of stay between the groups. In the interval of 10 years at a children's hospital, it now takes more time for patients with acute appendicitis to reach the pediatric surgeon, with a subsequent trend toward more frequent and complex morbidity. Factors in the present health care environment to account for these findings include changes in the initial physician-contact setting, greater misdiagnosis, and delayed surgical referral. Greater physician and public education is necessary to deter these trends.
Factors predictive of complicated appendicitis in children
International Surgery Journal
Background: Clinical features of acute appendicitis are often overlapping with other abdominal pathology in children. This increases the risk of complicated appendicitis (CA). It is still difficult to identify CA preoperatively. The study aims to identify pre operative risk factors in children for CA.Methods: A prospective study was conducted in pediatric surgery unit of department of general surgery of a university hospital of Kathmandu, Nepal. All children up to 16 years diagnosed and operated for appendicitis were included in the study. Based on intraoperative findings and histopathological examination (HPE), patients were grouped in simple appendicitis (SA) and CA. Pre-operative clinical and laboratory variables of between simple and CA were compared. P£0.05 was considered as significant.Results: A total of 73 children were included out of which 61 (83.6%) had SA and 12 (16.4%) had CA. Mean age of participants was 12.8±2.9 years. More than half (64.4%) of the participants were m...
Occupational Diseases and Environmental Medicine, 2021
Introduction: Acute appendicitis (AA) in children is the primary cause of urgent surgery in pediatric patients. Diagnosis of AA continues to be a challenge, especially in the youngest children, who often present with abdominal pain accompanied by nonspecific signs. As epidemiological data on the relationship between acute appendicitis and environmental factors are relatively few and the issue is still controversial, we conducted this study which compared two groups of patients with complicated and noncomplicated appendicitis in a sample of patients admitted to a MNCMCH. The aim of this study was to determine the risk factors for complications in acute appendicitis in the paediatric population. Methods: Our study was performed on 1003 children admitted for suspected acute appendicitis and underwent appendectomy at the MNCMCH, Ulaanbaatar Mongolia, between January 2019 and December 2019. The diagnosis was based on the results of pathological examination. The two groups of complicated (gangrenous and perforated) and noncomplicated (catarrhal and phlegmonous) acute appendicitis were compared. Results: 1003 pediatric patients (≤18 years old) were suspected of having acute appendicitis and subsequently underwent surgery. From a total of 967 patients, 56% (n = 542) were male, 44% (n = 425) were female (gender ratio was 1.3:1). The histological examination noted that 33.1% were uncomplicated, 66.9% were complicated. While the incidence of acute appendicitis was higher during winter, the highest incidence of complicated appendicitis was observed equally in winter and autumn without significant association (p = 0.541
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 ...
2021
Background: In the Gezira National Center of Pediatrics Surgery (GNCPS), we observed that most of the children presented with acute appendicitis coming from rural areas of Gezira state in Sudan and some of them are having perforated appendicitis at operation. This study is designed to reflect our local experience in GNCPS regarding the contributing risk factors and outcomes of management of children presented with perforated appendicitis. Methods: This prospective study comprised 200 consecutive patients (age <16 yrs) who were admitted with acute appendicitis at GNCPS between 2016 and 2017. Patients were divided into two groups: Perforated appendicitis group and non-perforated appendicitis (including; simple appendicitis, appendicular abscess, and appendicular mass) group. Results: Two patient’s groups were analyzed. Among 200 patients, 31 patients (15.5%) were classified in the Perforated Appendicitis group, and 169 patients (84.5%) were in the NonPerforated Appendicitis group. ...
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.
Post-operative Complications of Complicated Paediatric Appendicitis in a Tertiary Teaching Hospital
https://www.ijrrjournal.com/IJRR\_Vol.9\_Issue.1\_Jan2022/IJRR-Abstract02.html, 2022
Background: Acute appendicitis is a common surgical problem, with complicated appendicitis having significant post operative complications, which contribute significantly to cost of medical care. Methodology: A hospital based retrospective study was conducted in department of paediatric surgery, Thiruvananthapuram. Study population consisted of children treated with complicated appendicitis from January 2016 to June 2021. Results: The study had 30.4% surgical site soft tissue infection (SSI). There was 13.48% incidence of major complication, with laparoscopic and open appendicectomies having similar incidence even though not statistically significant. SSI was more common with appendicular abscess and post ileal appendix. Post operative intra-abdominal abscess is more common with open appendicectomy, generalised peritonitis, post ileal appendix and base/proximal perforation of appendix. Post operative adhesive intestinal obstruction was more common with laparoscopic appendicectomy, appendicular abscess and base/proximal perforation of appendix. Total hospital stay correlates significantly with duration of symptoms on presentation with mean hospital stay of 7.72 days. Conclusion: Complicated appendicitis have high incidence of post operative complications, 30.4% SSI and 13.48% serious complications like intra-abdominal collection and adhesive intestinal obstruction.
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...