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



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


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.


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 %).


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.


Pediatric Complicated Appendicitis Co-morbidities 


  1. 1.
    Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132(5):910–925PubMedGoogle Scholar
  2. 2.
    To T, Guttmann A, Dick P (2001) Inpatient and day surgery use by children in Ontario Toronto, Institute for Clinical Evaluative SciencesGoogle Scholar
  3. 3.
    Temple CL, Huchcroft SA, Temple WJ (1995) The natural history of appendicitis in adults: a prospective study. Ann Surg 221(3):278–281PubMedCrossRefGoogle Scholar
  4. 4.
    Eldar S, Nash E, Sabo E et al (1997) Delay of surgery in acute appendicitis. Am J Surg 173(3):194–198PubMedCrossRefGoogle Scholar
  5. 5.
    Ditillo MF, Dziura JD, Rabinovici R (2006) Is it safe to delay appendectomy in adults with acute appendicitis? Ann Surg 244(5):656–660PubMedCrossRefGoogle Scholar
  6. 6.
    Rothrock SG, Pagane J (2000) Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med 36:39–51PubMedCrossRefGoogle Scholar
  7. 7.
    Camp M, Chagnd DC, Zhang Y, Arnold M, Sharpe L, Gabre-Kidan A, Bathurst MA, Abdullah F (2010)Provider density and health system facility factors and their relationship to rates of pediatric perforated appendicitis in US counties. Arch Surg 145(12):1139–1144Google Scholar
  8. 8.
    Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP).
  9. 9.
    Abou-Nukta F, Bakhos C, Arroyo K et al (2006) Effects of delaying appendectomy for acute appendicitis for 12 to 24 hours. Arch Surg 141(5):504–507PubMedCrossRefGoogle Scholar
  10. 10.
    Omundsen M, Dennett E (2006) Delay to appendicectomy and associated morbidity: a retrospective review. ANZ J Surg 76(3):153–155PubMedCrossRefGoogle Scholar
  11. 11.
    Pittman-Waller VA, Myers JG, Stewart RM et al (2000) Appendicitis: why so complicated? Analysis of 5,755 consecutive appendectomies. Am Surg 66:548–553PubMedGoogle Scholar
  12. 12.
    Ponsky TA, Huang ZJ, Kittle K (2004) Hospital and patient level characteristics and the risk of appendiceal rupture and negative appendectomy in children. JAMA 292(16):1977–1982PubMedCrossRefGoogle Scholar
  13. 13.
    Lee SL, Yaghoubian, A, Kaji A (2011) Laparoscopic vs open appendectomy in children, outcomes comparison based on age, sex, and perforation status. Arch Surg 146(10):1118–1121Google Scholar

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

Personalised recommendations