Eur J Pediatr Surg 2021; 31(04): 347-352
DOI: 10.1055/s-0040-1714655
Original Article

Changes in Incidence and Management of Acute Appendicitis in Children—A Population-Based Study in the Period 2000–2015

Grith Laerkholm Hansen
1   Department of Pediatrics, Hvidovre Hospital, Hvidovre, Denmark
,
2   Department of Surgery, Hillerød Hospital, Hillerød, Denmark
,
Christian Jakobsen
1   Department of Pediatrics, Hvidovre Hospital, Hvidovre, Denmark
,
Anders Paerregaard
1   Department of Pediatrics, Hvidovre Hospital, Hvidovre, Denmark
› Author Affiliations

Abstract

Introduction Recent studies suggest that the epidemiology and management of appendicitis have changed during the last decades. The purpose of this population-based study was to examine this in the pediatric population in Denmark.

Materials and Methods Data were retrieved from the Danish National Patient Registry, the Danish Civil Registration System, and the Statbank Denmark. Patients aged 0 to 17 years diagnosed with appendicitis and appendectomized during the period 2000 to 2015 were included. The primary outcome was the annual incidences of appendicitis. Secondary outcomes were the annual percent of patients with appendicitis having a laparoscopic appendectomy, delay from admission to surgery, length of postoperative hospital stay, and 30-day postoperative mortality.

Results A total of 24,046 pediatric cases of appendicitis were identified. The annual incidence steadily declined until 2008 (–29%, all ages) and then remained stable. The surgical approach of choice changed from being open appendectomy in 2000 (97%) to laparoscopic appendectomy in 2015 (94%). Simultaneously, the duration of postoperative hospital stay declined from 41 hours (median) to 17 hours. Delay from admission until surgery did not change during the period. Only one child died within the 30-day postoperative period.

Conclusion In accordance with other recent studies from Western countries, we found significant changes in the incidence of acute appendicitis including a decline in all age groups except those below 5 years of age, a shift toward laparoscopic appendectomy, and decreasing time spent in the hospital during the years 2000 to 2015.



Publication History

Received: 25 December 2019

Accepted: 18 June 2020

Article published online:
31 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Andersen SB, Paerregaard A, Larsen K. Changes in the epidemiology of acute appendicitis and appendectomy in Danish children 1996-2004. Eur J Pediatr Surg 2009; 19 (05) 286-289
  • 2 Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990; 132 (05) 910-925
  • 3 Hardin Jr DMJ. Acute appendicitis: review and update. Am Fam Physician 1999; 60 (07) 2027-2034
  • 4 Al-Omran M, Mamdani M, McLeod RS. Epidemiologic features of acute appendicitis in Ontario, Canada. Can J Surg 2003; 46 (04) 263-268
  • 5 Davies GM, Dasbach EJ, Teutsch S. The burden of appendicitis-related hospitalizations in the United States in 1997. Surg Infect (Larchmt) 2004; 5 (02) 160-165
  • 6 Andersson RE. The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis. [Internet] World J Surg 2007; 31 (01) 86-92
  • 7 Luckmann R. Incidence and case fatality rates for acute appendicitis in California. A population-based study of the effects of age. Am J Epidemiol 1989; 129 (05) 905-918
  • 8 Andersson R, Hugander A, Thulin A, Nyström PO, Olaison G. Indications for operation in suspected appendicitis and incidence of perforation. BMJ 1994; 308 (6921): 107-110
  • 9 Livingston EH, Woodward WA, Sarosi GA, Haley RW. Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Ann Surg 2007; 245 (06) 886-892
  • 10 Andersson RE. Resolving appendicitis is common: further evidence. Ann Surg 2008; 247 (03) 553
  • 11 Almström M, Svensson JF, Svenningsson A, Hagel E, Wester T. Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987-2013. BJS Open 2018; 2 (03) 142-150
  • 12 Körner H, Söreide JA, Pedersen EJ, Bru T, Söndenaa K, Vatten L. Stability in incidence of acute appendicitis. A population-based longitudinal study. Dig Surg 2001; 18 (01) 61-66
  • 13 Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V. Changing epidemiology of acute appendicitis in the United States: study period 1993-2008. J Surg Res 2012; 175 (02) 185-190
  • 14 Aarabi S, Sidhwa F, Riehle KJ, Chen Q, Mooney DP. Pediatric appendicitis in New England: epidemiology and outcomes. J Pediatr Surg 2011; 46 (06) 1106-1114
  • 15 Ferris M, Quan S, Kaplan BS. et al. The global incidence of appendicitis: a systematic review of population-based studies. Ann Surg 2017; 266 (02) 237-241
  • 16 Svensson JF, Patkova B, Almström M. et al. Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Ann Surg 2015; 261 (01) 67-71
  • 17 Prechal D, Post S, Pechlivanidou I, Ronellenfitsch U. Feasibility, acceptance, safety, and effectiveness of antibiotic therapy as alternative treatment approach to appendectomy in uncomplicated acute appendicitis. Int J Colorectal Dis 2019; 34 (11) 1839-1847
  • 18 Salminen P, Paajanen H, Rautio T. et al. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. JAMA 2015; 313 (23) 2340-2348
  • 19 Prechal D, Damirov F, Grilli M, Ronellenfitsch U. Antibiotic therapy for acute uncomplicated appendicitis: a systematic review and meta-analysis. Int J Colorectal Dis 2019; 34 (06) 963-971
  • 20 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61 (04) 344-349
  • 21 Lynge E, Sandegaard JL, Rebolj M. The Danish National Patient Register. Scand J Public Health 2011; 39 (07) 30-33
  • 22 Pedersen CB. The Danish Civil Registration System. Scand J Public Health 2011; 39 (07) 22-25
  • 23 Kleif J, Thygesen LC, Gögenur I. Validity of the diagnosis of appendicitis in the Danish National Patient Register. Scand J Public Health 2020; 48 (01) 38-42
  • 24 Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet 2015; 386 (10000): 1278-1287
  • 25 Jaschinski T, Mosch CG, Eikermann M, Neugebauer EAM, Sauerland S. Laparoscopic versus open surgery for suspected appendicitis. [Internet] Cochrane Database Syst Rev 2018; 11: CD001546
  • 26 Nance ML, Adamson WT, Hedrick HL. Appendicitis in the young child: a continuing diagnostic challenge. Pediatr Emerg Care 2000; 16 (03) 160-162
  • 27 Lee SL, Stark R, Yaghoubian A, Shekherdimian S, Kaji A. Does age affect the outcomes and management of pediatric appendicitis?. J Pediatr Surg 2011; 46 (12) 2342-2345