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Intermediate-term evaluation of interval appendectomy in the pediatric population

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

Initial non-operative management of children with complicated appendicitis has been well studied but when comparing emergency procedures the long-term effectiveness of interval appendectomy remains undefined. This study aimed to determine the effects of interval appendectomy from the perspective of long-term follow-up.

Methods

A retrospective review of patients with complicated appendicitis between 2010 and 2017 was performed. The medical records of 471 patients with initial non-operative therapy and 377 patients treated with emergency appendectomy who served as controls were reviewed. Propensity score matching was performed to adjust for any potential selection bias in the two strategies. A comparison of the clinical outcomes, including short- and long-term postoperative complications, was conducted in the 348 matched patients.

Results

On presentation, there were no differences in age, weight, sex distribution, white blood cell (WBC), or procalcitonin (PCT) between the two groups, except for days of symptoms. The patients undergoing emergency appendectomy had a high American Society of Anesthesiology (ASA) score (p = 0.002). The patients who underwent initial non-operative therapy had a lower complication rate, including surgical wound infection [odds ratio (OR), 3.77; 95% CI 2.59–5.50; p < 0.001) and postoperative peritonitis or abscess (OR, 3.81; 95% CI 1.79–8.12; p < 0.001) than those who underwent emergency appendectomy. Furthermore, the incidence of adhesive small bowel obstruction (ASBO) was lower in patients who underwent initial non-operative therapy than in patients who underwent emergency appendectomy (OR, 4.6; 95% CI 0.99–21.41; p = 0.032).

Conclusions

Initial non-operative therapy with interval appendectomy was feasible for most patients with appendiceal abscesses and had advantages in terms of postoperative complications, especially regarding long-term obstruction events. Therefore, initial non-operative therapy with interval appendectomy should be considered the first treatment of choice for pediatric patients with complicated appendicitis.

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Authors and Affiliations

  1. Department of Pediatric General Surgery and Liver Transplantation, Childrens Hospital, Chongqing Medical University, 136 Zhongshan 2nd Rd., Chongqing, 400014, People’s Republic of China

    Yunfei Zhang, Qin Deng, Hai Zhu, Bailin Chen, Lin Qiu & Chunbao Guo

  2. Ministry of Education Key Laboratory of Child Development and Disorders, Childrens Hospital, Chongqing Medical University, Chongqing, People’s Republic of China

    Chunbao Guo

  3. Department of Burn and Plastic Surgery, Childrens Hospital, Chongqing Medical University, Chongqing 136 Zhongshan 2nd Rd.,, Chongqing, 400014, People’s Republic of China

    Lin Qiu

Authors
  1. Yunfei Zhang
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  2. Qin Deng
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  3. Hai Zhu
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  4. Bailin Chen
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  5. Lin Qiu
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  6. Chunbao Guo
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Contributions

YZ, HZ designed and analyzed the data and evaluated the manuscript. QD, BC, LQ performed the statistical calculations and analyzed the data. CG analyzed the data and wrote the paper.

Corresponding authors

Correspondence to Lin Qiu or Chunbao Guo.

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The authors declare that they have no conflict of interests.

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Zhang, Y., Deng, Q., Zhu, H. et al. Intermediate-term evaluation of interval appendectomy in the pediatric population. Eur J Trauma Emerg Surg 47, 1041–1047 (2021). https://doi.org/10.1007/s00068-019-01277-0

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  • DOI: https://doi.org/10.1007/s00068-019-01277-0

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