Appendiceal inflammation affects the length of stay following appendicectomy amongst children: a myth or reality?

Abstract

The effect of the severity of appendiceal inflammation on post-operative stay in children following appendicectomy has shown conflicting results. This study was conducted to determine the association between the severity of appendiceal inflammation and post-operative stay amongst children undergoing open appendicectomy. A retrospective cohort study was conducted at a District General Hospital for two years. A total of 204 patients were included in the study with an age range between 3 and 16 years. Females were 54.9% while the rest were male. Mean age was 12.5±3 years. The association of the severity of appendiceal inflammation and post-operative stay was assessed by multivariable Cox Proportional hazards model. Mean post-operative stay was 2.32 days (95% CI 2.14–2.51). Macroscopically perforated appendix, histological inflammation and post-operative complications were significantly associated with post-operative stay on univariable analysis (P<0.05). Whereas, the multivariable analysis showed that the post-operative stay was significantly prolonged only in case of either perforated appendix or post-operative complications while it remained unaffected by the histological inflammation.

Keywords

appendiceal inflammation / post-operative stay / paediatrics

References

[1] Rothrock SG, Pagane J. Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med2000; 36(1): 39-51

[2] Acheson J, Banerjee J. Management of suspected appendicitis in children. Arch Dis Child Educ Pract Ed2010; 95(1): 9-13

[3] Doria AS, Amernic H, Dick P, Babyn P, Chait P, Langer J, Coyte PC, Ungar WJ. Cost-effectiveness analysis of weekday and weeknight or weekend shifts for assessment of appendicitis. Pediatr Radiol2005; 35(12): 1186-1195

[4] Whisker L, Luke D, Hendrickse C, Bowley DM, Lander A. Appendicitis in children: a comparative study between a specialist paediatric centre and a district general hospital. J Pediatr Surg2009; 44(2): 362-367

[5] Alexander F, Magnuson D, DiFiore J, Jirousek K, Secic M. Specialty versus generalist care of children with appendicitis: an outcome comparison. J Pediatr Surg2001; 36(10): 1510-1513

[6] Foulds KA, Beasley SW, Maoate K. Factors that influence length of stay after appendicectomy in children. Aust N Z J Surg2000; 70(1): 43-46

[7] SAS 9.1.2. Cary, NC, USA: SAS Institute Inc. 2004

[8] SPSS for Windows. Chicago: SPSS Inc. 2005

[9] Siddique K, Baruah P, Bhandari S, Mirza S, Harinath G. Diagnostic accuracy of white cell count and C-reactive protein for assessing the severity of paediatric appendicitis. JRSM Short Rep2011; 2(7): 59

[10] Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA2007; 298(4): 438-451

[11] Morrow SE, Newman KD. Current management of appendicitis. Semin Pediatr Surg2007; 16(1): 34-40

[12] Nance ML, Adamson WT, Hedrick HL. Appendicitis in the young child: a continuing diagnostic challenge. Paediatric Emerg Care2000; 16(3): 160-162

[13] Kalliakmanis V, Pikoulis E, Karavokyros IG, Felekouras E, Morfaki P, Haralambopoulou G, Panogiorgou T, Gougoudi E, Diamantis T, Leppäniemi A, Tsigris C. Acute appendicitis: the reliability of diagnosis by clinical assessment alone. Scand J Surg2005; 94(3): 201-206

[14] Lord RVN, Sloane DR. Early discharge after open appendicectomy. Aust N Z J Surg1996; 66(6): 361-365

[15] Mallick MS. Appendicitis in pre-school children: a continuing clinical challenge. A retrospective study. Int J Surg2008; 6(5): 371-373

[16] Lander A. The role of imaging in children with suspected appendicitis: the UK perspective. Pediatr Radiol2007; 37(1): 5-9

[17] Wagner JM, McKinney WP, Carpenter JL. Does this patient have appendicitis? JAMA1996; 276(19): 1589-1594

[18] Chang YJ, Chao HC, Kong MS, Hsia SH, Yan DC. Misdiagnosed acute appendicitis in children in the emergency department. Chang Gung Med J2010; 33(5): 551-557

[19] Garcia Peña BM, Cook EF, Mandl KD. Selective imaging strategies for the diagnosis of appendicitis in children. Pediatrics2004; 113(1 Pt 1): 24-28

[20] Wu HP, Chen CY, Kuo IT, Wu YK, Fu YC. Diagnostic values of a single serum biomarker at different time points compared with Alvarado score and imaging examinations in pediatric appendicitis. J Surg Res2012; 174(2): 272-277

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