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Frongia G, Dostal F, Ziebell L, Vuille-Dit-Bille NR, Müller T, Schenk JP, Mehrabi A, Günther P. Delayed Surgery for Perforated Appendicitis is Feasible in Children Without Compromising the Outcome in Selected Cases. World J Surg 2022; 46:1980-1986. [PMID: 35445826 DOI: 10.1007/s00268-022-06561-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
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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Affiliation(s)
- G Frongia
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
| | - F Dostal
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - L Ziebell
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - N R Vuille-Dit-Bille
- Department of Pediatric Surgery, University Children's Hospital Basel, Basel, Switzerland
| | - T Müller
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - J P Schenk
- Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - A Mehrabi
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - P Günther
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
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Castro P, Rincón J, Sánchez C, Molina I, Buitrago G. Presurgical time and associated factors as predictors of acute perforated appendicitis: a prospective cohort study in a teaching pediatric hospital in Colombia. BMC Pediatr 2022; 22:49. [PMID: 35057783 PMCID: PMC8772156 DOI: 10.1186/s12887-022-03121-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background We aim to determine the association between out and in-hospital factors with time, from the beginning of the symptoms to the surgery, in patients with acute appendicitis treated at Fundación Hospital Pediatrico La Misericordia (HOMI) in Colombia. Methods Eleven month prospective cohort study of pediatric patients at HOMI with acute appendicitis diagnosis taken to surgery. Data from the out-of-hospital phase was collected by surveying parents, and the data regarding the in-hospital phase was completed with medical records. We analyzed the association between the time from the beginning of the symptoms to the surgery, and out and in-hospital factors associated with this time using generalized linear models. Results Eight hundred three patients were included in the study. Total pre-surgical time was longer in perforated appendicitis (PA) group (2.65 days, standard deviation (SD) 1.88 vs. 2.04 days, SD 1.45) (p < 0.01). Factors associated with longer total and out-of-hospital presurgical times were age under 4 years old, lower socioeconomic status, father as a caregiver, self-medication, and underestimating disease severity. Conclusions Out-of-hospital timing determines the longer pre-surgical time in complicated appendicitis. Younger age and lower socioeconomic status affect time significantly. We suggest the implementation of strategies in order to lower prehospital time, rates, and costs of complicated appendicitis. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03121-8.
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Cameron DB, Williams R, Geng Y, Gosain A, Arnold MA, Guner YS, Blakely ML, Downard CD, Goldin AB, Grabowski J, Lal DR, Dasgupta R, Baird R, Gates RL, Shelton J, Jancelewicz T, Rangel SJ, Austin MT. Time to appendectomy for acute appendicitis: A systematic review. J Pediatr Surg 2018; 53:396-405. [PMID: 29241958 DOI: 10.1016/j.jpedsurg.2017.11.042] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 10/21/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to develop recommendations regarding time to appendectomy for acute appendicitis in children within the context of preventing adverse events, reducing cost, and optimizing patient/parent satisfaction. METHODS The committee selected three questions that were addressed by searching MEDLINE, Embase, and the Cochrane Library databases for English language articles published between January 1, 1970 and November 3, 2016. Consensus recommendations for each question were made based on the best available evidence for both children and adults. RESULTS Based on level 3-4 evidence, appendectomy performed within 24h of admission in patients with acute appendicitis does not appear to be associated with increased perforation rates or other adverse events. Based on level 4 evidence, time from admission to appendectomy within 24h does not increase hospital cost or length of stay (LOS). Data are currently limited to determine an association between the timing of appendectomy and parent/patient satisfaction. CONCLUSIONS There is a paucity of high-quality evidence in the literature regarding timing of appendectomy for patients with acute appendicitis and its association with adverse events or resource utilization. Based on available evidence, appendectomy performed within the first 24h from presentation is not associated with an increased risk of perforation or adverse outcomes. TYPE OF STUDY Systematic Review of Level 1-4 studies.
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Affiliation(s)
| | - Regan Williams
- Department of Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.
| | - Yimin Geng
- University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Ankush Gosain
- Department of Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN
| | - Meghan A Arnold
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, CS Mott Children's Hospital, Ann Arbor, MI
| | - Yigit S Guner
- Department of Surgery, University of California Irvine and Division of Pediatric Surgery Children's Hospital of Orange County
| | - Martin L Blakely
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, TN
| | - Cynthia D Downard
- Division of Pediatric Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Adam B Goldin
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA
| | - Julia Grabowski
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL
| | - Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital
| | - Robert Baird
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, QC, Canada
| | - Robert L Gates
- Division of Pediatric Surgery, Greenville Health System, Greenville, SC
| | - Julia Shelton
- Division of Pediatric Surgery, University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | - Tim Jancelewicz
- Department of Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN
| | - Shawn J Rangel
- Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Mary T Austin
- Division of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX
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Abstract
Purpose With varied reports on the impact of time to appendectomy on clinical outcomes, the purpose of this study was to determine the effect of preoperative in-hospital delay on the outcome for patients with acute appendicitis. Methods A retrospective review of 1,076 patients who had undergone an appendectomy between January 2010 and December 2013 was conducted. Results The outcomes of surgery and the pathologic findings were analyzed according to elapsed time. The overall elapsed time from onset of symptoms to surgery was positively associated with advanced pathology, increased number of complications, and prolonged hospital stay. In-hospital elapsed time was not associated with any advanced pathology (P = 0.52), increased number of postoperative complications (P = 0.14), or prolonged hospital stay (P = 0.24). However, the complication rate was increased when the in-hospital elapsed time exceeded 18 hours. Conclusion Advanced pathology and postoperative complication rate were associated with overall elapsed time from symptom onset to surgery rather than in-hospital elapse time. Therefore, a short-term delay of an appendectomy should be acceptable.
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Affiliation(s)
- Jae Min Lee
- Department of Surgery, Dongguk University Ilsan Hospital, Ilsan, Korea
| | - Beom Seok Kwak
- Department of Surgery, Dongguk University Ilsan Hospital, Ilsan, Korea
| | - Young Jin Park
- Department of Surgery, Dongguk University Ilsan Hospital, Ilsan, Korea
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