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Delayed Surgery for Perforated Appendicitis is Feasible in Children Without Compromising the Outcome in Selected Cases

Abstract

Background and aim

The relationship between time to surgery and risk of postoperative complications and re-intervention has not been conclusively investigated in pediatric perforated appendicitis (PA). The aim of this study was to determine whether time to appendectomy (TTA) is a risk factor for postoperative complications and re-intervention in a cohort of children undergoing appendectomy for PA.

Methods

A total of 254 children (age: 8.7 ± 3.7 years) undergoing appendectomy for PA were retrospectively evaluated and stratified into Group I–III according to the Clavien-Dindo classification for postoperative complications (Group I n = 218, 86%; Group II n = 7, 3%; Group III n = 29, 11%).

Results

The TTA was comparable between all groups (group I: 8.8 ± 9.2 h; group II: 7.8 ± 5.3 h; group III: 9.5 ± 9.6 h; overall: 8.8 ± 9.1 h; p = 0.885). A C-reactive protein (CRP) value at admission of  ≥128.6 mg/l indicated a higher risk for developing Grade II complications with no need for re-intervention (OR: 3.963; 95% CI: 1.810–8.678; p = 0.001) and Grade III complications with the need for re-intervention (OR: 3.346; 95% CI: 1.456–7.690; p = 0.004). This risk was independent of the TTA (OR: 1.007; 95% CI: 0.980–1.035; p = 0.613).

Conclusions

Appendectomy can be delayed by an average time delay of about 9 h in children with PA without increasing the risk of postoperative complications and re-intervention, also in patients at high risk defined by the initial CRP level ≥ 128.6 mg/l. This data may support the correct risk-adjusted scheduling of surgical interventions in times of limited capacity.

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Data availability

This published article contains all analyzed data.

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Each of the authors substantially contributed to the study, fulfills the COPE requirements for authorship, and approved the manuscript in its’ final version.

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Correspondence to G. Frongia.

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Authors have no conflict of interests to declare. No financial support was received for this article.

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The local ethical committee approved the study protocol.

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Due to the retrospective nature of this study, no patient’s informed consent was necessary.

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Frongia, G., Dostal, F., Ziebell, L. et al. Delayed Surgery for Perforated Appendicitis is Feasible in Children Without Compromising the Outcome in Selected Cases. World J Surg 46, 1980–1986 (2022). https://doi.org/10.1007/s00268-022-06561-6

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