Pediatric Appendectomy: an Analysis of 22,334 Cases from the Pediatric National Surgical Quality Improvement Program Dat
- PDF / 187,560 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 91 Downloads / 184 Views
RESEARCH COMMUNICATION
Pediatric Appendectomy: an Analysis of 22,334 Cases from the Pediatric National Surgical Quality Improvement Program Data Alexander M. Troester 1 & Alan F. Utria 1 & Paolo Goffredo 1
&
Edward Cho 1 & Peige Zhou 1 & Imran Hassan 1
Received: 20 June 2020 / Accepted: 10 August 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract This data is mandatory Please provide. Keywords Appendectomy . Pediatric surgery . NSQIP . Outcomes . Appendicitis
Introduction Appendicitis is the most common pediatric surgical 1 emergency, accounting for approximately one-third of childhood admissions for abdominal pain and nearly 30% of the cumulative cost of all pediatric general sur2 gical conditions combined. Due to the paucity of granular data, perioperative counseling represents a challenging task for the healthcare provider. Moreover, in the setting of increased consideration to non-operative management of appendicitis, it is essential to have contemporary data on surgical outcomes to evaluate the comparative effectiveness of both approaches. The aim of the current study was to evaluate 30-day outcomes following appendectomy stratified by uncomplicated (UA) and complicated (CA) appendicitis, as well as to identify risk factors for postoperative morbidity using a nationally representative database.
Methods The American College of Surgeons National Surgical Quality Improvement Program Pediatric database was
* Paolo Goffredo [email protected] 1
Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 1516 JCP, Iowa City, IA 52242, USA
used to identify patients (0–18 years) who underwent 3 appendectomy, 2015–2016. Patient-, disease-, and treatment-related factors affecting short-term outcomes were analyzed using univariate and multivariable analyses. This study was deemed exempted from IRB review.
Results A total number of 22,334 appendectomies were identified; the majority of which were done for UA (71%). When comparing uncomplicated and complicated appendicitis, patients with CA were younger (10.3 vs 11.6 years), African-American (9.3 vs 7.8%), presented with sepsis (69.8% vs 45.3%, all p < 0.001), had elevated WBC count (16.3 vs 14.3 103/mm3, p < 0.001) and likely to undergo an open approach (14.4 vs 4.1%). As compared with UA, CA patients had higher rates of overall complications (27.0% vs 8.8%), postoperative sepsis (0.9 vs 0.2%), increased lengths of stay (4 vs 1 days), ED visits (11.4 vs 6.3%), readmissions (6.8 vs 2.3%), and reoperations (2.2 vs 0.6%, all p < 0.001). Laparoscopic appendectomy for UA had a low rate of severe complications (3.4%) and readmissions (2.3%). Pediatric surgeons performed most of the procedures (> 90%). In the overall multivariable model, including both UA and CA, the latter was consistently associated with worse outcomes: overall postoperative morbidity (odds ratio [OR] 2.24), infectious complications (OR 3.27), and ED visits or readmissions (OR 1.52, all p < 0.001).
J Gastrointest Surg Table 1 Multivariable analysis f
Data Loading...
