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Pediatric Surgery International

, Volume 30, Issue 12, pp 1265–1271 | Cite as

Determinants of postoperative abscess occurrence and percutaneous drainage in children with perforated appendicitis

  • Sherif EmilEmail author
  • Sherif Elkady
  • Layla Shbat
  • Fouad Youssef
  • Robert Baird
  • Jean-Martin Laberge
  • Pramod Puligandla
  • Kenneth Shaw
Original Article

Abstract

Purpose

Postoperative abscesses after perforated appendicitis have no clear risk factors or indications for percutaneous drainage. Our study addressed these two issues.

Methods

A logistic regression model was used to delineate risk factors for postoperative abscess in children with perforated appendicitis treated during a recent 5-year period. Drainage of abscess was compared to antibiotic treatment.

Results

Postoperative abscess occurred in 42 (14.8 %) of 284 patients. Higher WBC count, presence of bowel obstruction at presentation, diffuse peritonitis with a dominant abscess at surgery, and one specific surgeon were significantly associated with postoperative abscess, while fever or pain requiring narcotics at the time of abscess diagnosis was significantly associated with drainage. Compared to non-drainage, those drained had longer hospital stay including readmissions (15.9 ± 5.3 vs. 12.2 ± 4.6 days, p < 0.005) and less readmissions (9.5 vs. 33.3 %, p = 0.06). Over the 5-year period, there was no increased trend in abscess occurrence (p = 0.56), but there was an increased trend in the use of percutaneous drainage (p = 0.02).

Conclusions

The risk of a postoperative abscess can be predicted by specific clinical characteristics, surgical findings, and treatment-related factors. Percutaneous drainage was associated with longer hospital stays, but less readmissions.

Keywords

Appendicitis Perforated Children Abscess Risk factors Percutaneous Drainage 

Notes

Acknowledgments

We would like to thank Dr. Xianming Tan of the Biostatistics Core Facility, McGill University Health Centre Research Institute for providing assistance with the statistical analyses.

Conflict of interest

None.

References

  1. 1.
    Cheong LHA, Emil S (2014) Outcomes of pediatric appendicitis: an international comparison of the United States and Canada. JAMA Surg 149:50–55PubMedCrossRefGoogle Scholar
  2. 2.
    Emil S, Taylor M, Ndiforchu F, Nguyen N (2006) What are the true advantages of a pediatric appendicitis clinical pathway? Am Surg 72:885–889PubMedGoogle Scholar
  3. 3.
    Fishman SJ, Pelosi L, Klavon SL, O’Rourke EJ (2000) Perforated appendicitis: prospective outcome analysis for 150 children. J Pediatr Surg 35:923–926PubMedCrossRefGoogle Scholar
  4. 4.
    Emil S, Laberge J-M, Mikhail P, Baican L, Flageole H, Nguyen L, Shaw K (2003) Appendicitis in children: a ten-year update of therapeutic recommendations. J Pediatr Surg 38:236–242PubMedCrossRefGoogle Scholar
  5. 5.
    Henry MCW, Walker A, Silverman BL, Gollin G, Islam S, Sylvester K, Moss L (2007) Risk factors for the development of abdominal abscess following operation for perforated appendicitis in children. Arch Surg 142:236–241PubMedCrossRefGoogle Scholar
  6. 6.
    Fike FB, Mortellaro VE, Juang D, Sharp SW, Ostlie DJ, St. Peter S (2011) The impact of postoperative abscess formation in perforated appendicitis. J Surg Res 170:24–26PubMedCrossRefGoogle Scholar
  7. 7.
    St Peter SD, Adibe OO, Iqbal CW, Fike FB, Sharp SW, Juang D, Lanning D, Murphy JP, Andrews WS, Sharp RJ, Snyder CL, Holcomb GW, Ostlie DJ (2012) Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis. Ann Surg 256:581–585PubMedCrossRefGoogle Scholar
  8. 8.
    Nataraja RM, Teague WJ, Galea J, Moore L, Haddad MJ, Tsang T, Khurana S, Clarke SA (2012) Comparison of intraabdominal abscess formation after laparoscopic and open appendicectomies in children. J Pediatr Surg 47:317–321PubMedCrossRefGoogle Scholar
  9. 9.
    Fallon SC, Hassan SF, Larimer EL, Rodriguez JR, Brandt ML, Wesson DE, Palazzi DL, Lopez ME (2013) Modification of an evidence-based protocol for advanced appendicitis in children. J Surg Res 185:273–277PubMedCrossRefGoogle Scholar
  10. 10.
    Emil S, Gaied F, Lo A, Laberge JM, Puligandla P, Shaw K, Baird R, Bernard C, Blumenkrantz M, Nguyen V-H (2012) Gangrenous appendicitis in children: a prospective evaluation of definition, bacteriology, histopathology, and outcomes. J Surg Res 177:123–126PubMedCrossRefGoogle Scholar
  11. 11.
    Neilson IR, Laberge JM, Nguyen LT, Moir C, Doody D, Sonnino RE, Youssef S, Guttman FM (1990) Appendicitis in children: current therapeutic recommendations. J Pediatr Surg 25:1113–1116PubMedCrossRefGoogle Scholar
  12. 12.
    Taylor M, Emil S, Nguen N, Ndiforchu F (2005) Emergent vs urgent appendectomy in children: a study of outcomes. J Pediatr Surg 40:1912–1915PubMedCrossRefGoogle Scholar
  13. 13.
    Emil SGS, Taylor MB (2007) Appendicitis in children treated by pediatric versus general surgeons. J Am Coll Surg 204:34–39PubMedCrossRefGoogle Scholar
  14. 14.
    Taqi E, Al Hadher S, Ryckman J, Su W, Aspirot A, Puligandla P, Flageole H, Laberge JM (2008) Outcome of laparoscopic appendectomy for perforated appendicitis in children. J Pediatr Surg 43:893–895PubMedCrossRefGoogle Scholar
  15. 15.
    Cheong LHA, Emil S (2014) Determinants of appendicitis outcomes in Canadian children. J Pediatr Surg 49:777–781PubMedCrossRefGoogle Scholar
  16. 16.
    Singh AK, Hahn PF, Gervais D, Vijayraghavan G, Mueller PR (2008) Dropped appendicolith: CT findings and implications for management. AJR 190:707–711PubMedCrossRefGoogle Scholar
  17. 17.
    Narci A, Karaman I, Karaman A, Erdogan D, Cavusoglu YH, Aslan MK, Cakmak O (2007) Is peritoneal draiange necessary in childhood peforated appendicitis?––A comparative study. J Pediatr Surg 42:1864–1868PubMedCrossRefGoogle Scholar
  18. 18.
    Allemann P, Probst H, Demartines N, Schafer M (2011) Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis––the role of routine abdominal drainage. Pediatr Surg Int 396:63–68Google Scholar
  19. 19.
    Van Wijck K, de Jong JR, van Heurn WE, van der Zee DC (2010) Prolonged antibiotic treatment does not prevent intra-abdominal abscesses in perforated appendicitis. World J Surg 34:3049–3053PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Cheong LHA, Emil S. Pediatric laparoscopic appendectomy: a population-based study of trends, associations, and outcomes. J Pediatr Surg. In press.Google Scholar
  21. 21.
    Mosdell DM, Morris DM, Fry DE (1994) Peritoneal cultures and antibiotic therapy in pediatric perforated appendicitis. Am J Surg 167:313–316PubMedCrossRefGoogle Scholar
  22. 22.
    Bilik R, Burnweit C, Shandling B (1998) Is abdominal cavity culture of any value in appendicitis? Am J Surg 175:267–270PubMedCrossRefGoogle Scholar
  23. 23.
    Kokoska ER, Silen ML, Tracy TF, Dillon PA, Kennedy DJ, Cradock TV, Weber TR (1999) The impact of intraoperative culture on treatment and outcome in children with perforated appendicitis. J Pediatr Surg 34:749–753PubMedCrossRefGoogle Scholar
  24. 24.
    Celik A, Ergun O, Ozcan C, Aldemir H, Balik E (2003) Is it justified to obtain routine peritoneal fluid cultures during appendectomy in children? Pediatr Surg Int 19:632–634PubMedCrossRefGoogle Scholar
  25. 25.
    Solomkin JS, Mazuski JE, Bradley JS et al (2010) Diagnosis and management of complicated intra-abdominal infection in adults and children : guidelines by the surgical infection society and the infectious diseases society of America. Surg Infect 11:79–109CrossRefGoogle Scholar
  26. 26.
    Ein SH, Wales P, Langer JC, Daneman A (2008) Is there a role for routine abdominal imaging in predicting postoperative intraabdominal abscess formation after appendectomy for pediatric ruptured appendix? Pediatr Surg Int 24:307–309PubMedCrossRefGoogle Scholar
  27. 27.
    Jameson DH, Chait PG, Filler R (1997) Interventional drainage of appendiceal abscess in children. AJR 169:1619–1622CrossRefGoogle Scholar
  28. 28.
    Gorenstein A, Gewurtz G, Serour F, Somekh E (1994) Postappendectomy intra-abdominal abscess: a therapeutic approach. Arch Dis Child 70:400–402PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Heloury Y, Baron M, Bourgoin S, Wetzel O, Lejus C, Plattner V (1994) Medical treatment of postappendectomy intraperitoneal abscesses in children. Eur J Pediatr Surg 5:149–151CrossRefGoogle Scholar
  30. 30.
    Okoye BO, Rampersad B, Marantos A, Abernethy LJ, Losty PD, Lloyd DA (1998) Abscess after appendicectomy in children: the role of conservative management. Br J Surg 85:1111–1113PubMedCrossRefGoogle Scholar
  31. 31.
    Dobremez E, Lavrand F, Lefevre Y, Boer M, Bondonny J-M, Vergnes P (2003) Treatment of post-appendectomy intra-abdominal deep abscesses. Eur J Pediatr Surg 13:393–397PubMedCrossRefGoogle Scholar
  32. 32.
    Forgues D, Habbig S, Diallo AF, Kaifa N, Lopez M, Allal H, Guibal MP, Sabatier-Laval E, Galifer RB (2007) Post-appendectomy intra-abdominal abscesses––can they successfully be managed with the sole use of antibiotic therapy? Eur J Pediatr Surg 17:104–109PubMedCrossRefGoogle Scholar
  33. 33.
    Dhaou MB, Ghorbel S, Chouikh T, Charieg A, Nouira F, Ben Khalifa S, Khemakhem R, Jlidi S, Chaouachi B (2010) Conservative management of post-appendicectomy intra-abdominal abscesses. Ital J Pediatrics 36:68–71CrossRefGoogle Scholar
  34. 34.
    Piper HG, Derinkuyu B, Koral K, Perez EA, Murphy JT (2011) Is it necessary to drain all postoperative fluid collections after appendectomy for perforated appendicitis? J Pediatr Surg 46:1126–1130PubMedCrossRefGoogle Scholar
  35. 35.
    Gasior AC, Knott EM, Ostlie DJ, St Peter SD (2013) To drain or not to drain: an analysis of abscess drains in the treatment of appendicitis with abscess. Pediatr Surg Int 29:455–458PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Sherif Emil
    • 1
    Email author
  • Sherif Elkady
    • 1
  • Layla Shbat
    • 1
  • Fouad Youssef
    • 1
  • Robert Baird
    • 1
  • Jean-Martin Laberge
    • 1
  • Pramod Puligandla
    • 1
  • Kenneth Shaw
    • 1
  1. 1.Division of Pediatric General and Thoracic SurgeryThe Montreal Children’s HospitalMontrealCanada

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