Pediatric Surgery International

, Volume 28, Issue 7, pp 697–701 | Cite as

Missed opportunities in the treatment of pediatric appendicitis

  • Justin Lee
  • David B. Tashjian
  • Kevin P. Moriarty
Original Article

Abstract

Introduction

This study sought to evaluate the outcomes of in-hospital delay and determine associated co-morbidities in the treatment of pediatric acute appendicitis.

Methods

This was a retrospective analysis of the national inpatient sample from 2000 to 2008. Immediate treatment was defined as treatment in hospital day 0 or 1. Delay in treatment was defined as treatment in hospital day 2 and beyond.

Results

During the study period, 683,016 pediatric appendicitis were identified. 17,737 (2.6 %) experienced a delay in treatment. Multivariate analysis identified associated co-morbidities for delay in treatment: ALL (OR 12.84, CI 11.04–14.94), AML (OR 9.41, CI 7.58–11.68), neutropenia (OR 5.53, CI 4.60–6.65), and ovarian cyst without torsion (OR 3.17, CI 2.94–3.42). Surgical management included more than 13-fold increase in drainage procedures (5.5 vs. 0.4 %), sixfold increase in cecectomy (1.2 vs. 0.2 %), 14-fold increase in hemicolectomy (1.4 vs. 0.1 %), 11-fold increase in small bowel laceration suture repair (1.1 vs. 0.1 %), and 15-fold increase in small bowel resection (1.5 vs. 0.1 %).

Conclusions

In-hospital delay beyond 2 days is associated with significant negative outcomes with regard to complications, economic burden, and subsequent surgical management. Using the co-morbidity index, high-risk co-morbidities with associated delay in treatment were identified.

Keywords

Pediatric Complicated Appendicitis Co-morbidities 

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Justin Lee
    • 1
    • 2
    • 3
  • David B. Tashjian
    • 1
  • Kevin P. Moriarty
    • 1
  1. 1.Baystate Children’s HospitalTufts University School of MedicineSpringfieldUSA
  2. 2.St. Elizabeth Medical CenterTufts University School of MedicineBostonUSA
  3. 3.BostonUSA

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