Eur J Pediatr Surg 2021; 31(02): 191-198
DOI: 10.1055/s-0040-1712508
Original Article

A Nationwide Cohort Study of Outcome after Pediatric Appendicitis

1   Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
2   Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
,
Martin Salö
1   Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
2   Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
,
Saurabh Saluja
3   Department of Surgery, Weill Cornell Medicine, New York, New York, United States
,
Sanna Bergbrant
1   Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
,
Louise Olsson
1   Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
,
Jonas Björk
4   Department of Laboratory Medicine, Lund University, Lund, Sweden
5   Clinical Studies Sweden – Forum South, Skåne University Hospital, Lund, Skåne, Sweden
,
Lars Hagander
1   Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
2   Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
› Author Affiliations
Funding This study has been funded by Anna Lisa & Sven-Eric Lundgren Foundation for Medical Research; Skåne Region ALF Educational grants to E.O. and Project grants to L.H.; and Svenska Läkaresällskapet Research grants for young investigators.

Abstract

Introduction Children with appendicitis often present with complicated disease. The aim of this study was to describe the clinical management of pediatric appendicitis, and to report how disease severity and operative modality are associated with short- and long-term risks of adverse outcome.

Materials and Methods A nationwide retrospective cohort study of all Swedish children (<18 years) diagnosed with appendicitis, 2001 to 2014 (n = 38,939). Primary and secondary outcomes were length of stay, surgical site infections, readmissions, 30-day mortality, and long-term risk of surgery for small bowel obstruction (SBO). Implications of complicated disease and operative modality were assessed with adjustment for age, gender, and trends over time.

Results Complicated appendicitis was associated with longer hospital stay (4 vs. 2 days, p < 0.001), increased risk of surgical site infection (5.9 vs. 2.3%, adjusted odds ratio [aOR]: 2.64 [95% confidence interval, CI: 2.18–3.18], p < 0.001), readmission (5.5 vs. 1.2, aOR: 4.74 [95% CI: 4.08–5.53], p < 0.001), as well as long-term risk of surgery for SBO (0.7 vs. 0.2%, adjusted hazard ratio [aHR]: 3.89 [95% CI: 2.61–5.78], p < 0.001). Intended laparoscopic approach was associated with reduced risk of surgical site infections (2.3 vs. 3.1%, aOR: 0.74 [95% CI: 0.62–0.89], p = 0.001), but no overall reduction in risk for SBO; however, successful laparoscopic appendectomy was associated with less SBO during follow-up compared with open appendectomy (aHR: 0.27 [95% CI: 0.11–0.63], p = 0.002).

Conclusion Children treated for complicated appendicitis are at risk of substantial short- and long-term morbidities. Fewer surgical site infections were seen after intended laparoscopic appendectomy, compared with open appendectomy, also when converted procedures were accounted for.

Supplementary Material



Publication History

Received: 19 November 2019

Accepted: 16 April 2020

Publication Date:
26 June 2020 (online)

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