A Nationwide Cohort Study of Outcome after Pediatric Appendicitis.
Eur J Pediatr Surg
; 31(2): 191-198, 2021 Apr.
Article
en En
| MEDLINE
| ID: mdl-32590867
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 ANDMETHODS:
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.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Readmisión del Paciente
/
Apendicectomía
/
Apendicitis
/
Infección de la Herida Quirúrgica
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
Límite:
Adolescent
/
Child
/
Female
/
Humans
/
Male
País/Región como asunto:
Europa
Idioma:
En
Revista:
Eur J Pediatr Surg
Asunto de la revista:
PEDIATRIA
Año:
2021
Tipo del documento:
Article
País de afiliación:
Suecia