Organ Space Infection After Pediatric Appendectomy
Organ Space Infection After Pediatric Appendectomy
A total of 5097 appendectomies were included, with 11% (583/5097) performed as open procedures. Eighty-eight percent of appendectomies started as laparoscopic cases (4514/5097), with 41 cases converted to open procedures (0.8%). Figure 1 compares the percentage of laparoscopic and open cases by various subpopulations including sex (1A), age quartile (1B), obesity (1C), and appendicitis severity (1D). Patient and perioperative characteristics of each operative approach are presented in Table 1. Patients in the open appendectomy group tended to be younger, have a higher ASA class, and higher rates of preoperative sepsis, emergency operations, and complicated appendicitis. The mean number of days from admission to surgical intervention was similar between the laparoscopic and open groups (0.25 ± 0.5 vs 0.26 ± 0.8; P = 0.644). In addition, the mean operative duration in minutes was comparable between the laparoscopic and open groups (47.7 ± 29.6 vs 49.5 ± 31.8; P = 0.205). The laparoscopic appendectomy group had a shorter mean days of postoperative stay than the open appendectomy group (2.1 ± 2.7 vs 3.9 ± 3.8; P < 0.001).
(Enlarge Image)
Figure 1.
Operative approach in subpopulations undergoing acute appendectomy. Operative approach by (A) sex, (B) age quartile, (C) obesity, and (D) appendicitis severity.
Overall, 98% of appendectomies (4995/5097) were performed by pediatric surgeons and 2% (102/5097) were performed by general surgeons. Pediatric surgeons performed open appendectomies in 11.5% of their cases, whereas general surgeons performed open appendectomies in 7.8% of their cases (P = 0.249). There was a higher rate of complicated appendicitis treated by pediatric surgeons (29.4% vs 15.7%; P = 0.003). As expected, more than half of the patients treated by general surgeons were older than 14 years, whereas this age group comprised only a quarter of the patients treated by pediatric surgeons.
There were a total of 223 children (4.4%) who developed SSI within 30 days of surgery. This comprised a total of 155 OSIs and 70 incisional complications (2 patients developed both). Univariate analysis of patient and perioperative factors associated with OSIs, incisional complications, and SSIs is presented in Table 2. On unadjusted analysis, children undergoing open appendectomy had 1.8 times the relative odds of developing OSI (OR = 1.82; 95% confidence interval, 1.21–2.76; P = 0.004) compared with those having laparoscopic surgery. The unadjusted rates of incisional complications were similar between both operative approaches (OR = 1.15; 95% confidence interval, 0.57–2.32; P = 0.707).
After adjusting for pertinent patient and operative factors with multivariable analysis, the effect of operative approach on the development of SSI was no longer significant. Table 3 displays the adjusted ORs for OSIs and incisional complications with the covariates used in each model. Significant predictors for OSI included complicated appendicitis, wound class III/IV, preoperative sepsis, and longer operative time. Obesity, complicated appendicitis, and prolonged operative time were associated with incisional complications, whereas operative technique remained insignificant. The multivariable models were used to calculate the probability of postoperative OSI and incisional complication for various clinical scenarios (Table 4).
There were 63 reoperations (1.2%) related to the primary appendectomy within the cohort. Of the reoperations, 43% involved reexploration of the abdomen via laparotomy or laparoscopy and 52% involved abscess drainage (wound, intra-abdominal, retroperitoneal). There were 221 unplanned readmissions (4.3%) within 30 days of surgery. Seventy-seven percent of the unplanned readmissions (170/221) had a known cause documented. Sixty percent of readmissions with a documented cause were due to SSI, 12% due to postoperative pain, and 9% due to ileus or obstruction.
Results
A total of 5097 appendectomies were included, with 11% (583/5097) performed as open procedures. Eighty-eight percent of appendectomies started as laparoscopic cases (4514/5097), with 41 cases converted to open procedures (0.8%). Figure 1 compares the percentage of laparoscopic and open cases by various subpopulations including sex (1A), age quartile (1B), obesity (1C), and appendicitis severity (1D). Patient and perioperative characteristics of each operative approach are presented in Table 1. Patients in the open appendectomy group tended to be younger, have a higher ASA class, and higher rates of preoperative sepsis, emergency operations, and complicated appendicitis. The mean number of days from admission to surgical intervention was similar between the laparoscopic and open groups (0.25 ± 0.5 vs 0.26 ± 0.8; P = 0.644). In addition, the mean operative duration in minutes was comparable between the laparoscopic and open groups (47.7 ± 29.6 vs 49.5 ± 31.8; P = 0.205). The laparoscopic appendectomy group had a shorter mean days of postoperative stay than the open appendectomy group (2.1 ± 2.7 vs 3.9 ± 3.8; P < 0.001).
(Enlarge Image)
Figure 1.
Operative approach in subpopulations undergoing acute appendectomy. Operative approach by (A) sex, (B) age quartile, (C) obesity, and (D) appendicitis severity.
Overall, 98% of appendectomies (4995/5097) were performed by pediatric surgeons and 2% (102/5097) were performed by general surgeons. Pediatric surgeons performed open appendectomies in 11.5% of their cases, whereas general surgeons performed open appendectomies in 7.8% of their cases (P = 0.249). There was a higher rate of complicated appendicitis treated by pediatric surgeons (29.4% vs 15.7%; P = 0.003). As expected, more than half of the patients treated by general surgeons were older than 14 years, whereas this age group comprised only a quarter of the patients treated by pediatric surgeons.
There were a total of 223 children (4.4%) who developed SSI within 30 days of surgery. This comprised a total of 155 OSIs and 70 incisional complications (2 patients developed both). Univariate analysis of patient and perioperative factors associated with OSIs, incisional complications, and SSIs is presented in Table 2. On unadjusted analysis, children undergoing open appendectomy had 1.8 times the relative odds of developing OSI (OR = 1.82; 95% confidence interval, 1.21–2.76; P = 0.004) compared with those having laparoscopic surgery. The unadjusted rates of incisional complications were similar between both operative approaches (OR = 1.15; 95% confidence interval, 0.57–2.32; P = 0.707).
After adjusting for pertinent patient and operative factors with multivariable analysis, the effect of operative approach on the development of SSI was no longer significant. Table 3 displays the adjusted ORs for OSIs and incisional complications with the covariates used in each model. Significant predictors for OSI included complicated appendicitis, wound class III/IV, preoperative sepsis, and longer operative time. Obesity, complicated appendicitis, and prolonged operative time were associated with incisional complications, whereas operative technique remained insignificant. The multivariable models were used to calculate the probability of postoperative OSI and incisional complication for various clinical scenarios (Table 4).
There were 63 reoperations (1.2%) related to the primary appendectomy within the cohort. Of the reoperations, 43% involved reexploration of the abdomen via laparotomy or laparoscopy and 52% involved abscess drainage (wound, intra-abdominal, retroperitoneal). There were 221 unplanned readmissions (4.3%) within 30 days of surgery. Seventy-seven percent of the unplanned readmissions (170/221) had a known cause documented. Sixty percent of readmissions with a documented cause were due to SSI, 12% due to postoperative pain, and 9% due to ileus or obstruction.
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