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.
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References
Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132(5):910–925
To T, Guttmann A, Dick P (2001) Inpatient and day surgery use by children in Ontario Toronto, Institute for Clinical Evaluative Sciences
Temple CL, Huchcroft SA, Temple WJ (1995) The natural history of appendicitis in adults: a prospective study. Ann Surg 221(3):278–281
Eldar S, Nash E, Sabo E et al (1997) Delay of surgery in acute appendicitis. Am J Surg 173(3):194–198
Ditillo MF, Dziura JD, Rabinovici R (2006) Is it safe to delay appendectomy in adults with acute appendicitis? Ann Surg 244(5):656–660
Rothrock SG, Pagane J (2000) Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med 36:39–51
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):1139–1144
Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP). http://www.ahrq.gov/data/hcup/
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):504–507
Omundsen M, Dennett E (2006) Delay to appendicectomy and associated morbidity: a retrospective review. ANZ J Surg 76(3):153–155
Pittman-Waller VA, Myers JG, Stewart RM et al (2000) Appendicitis: why so complicated? Analysis of 5,755 consecutive appendectomies. Am Surg 66:548–553
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):1977–1982
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):1118–1121
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Lee, J., Tashjian, D.B. & Moriarty, K.P. Missed opportunities in the treatment of pediatric appendicitis. Pediatr Surg Int 28, 697–701 (2012). https://doi.org/10.1007/s00383-012-3108-4
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DOI: https://doi.org/10.1007/s00383-012-3108-4