Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

A Nationwide Cohort Study of Outcome after Pediatric Appendicitis

Omling, Erik LU orcid ; Salö, Martin LU ; Saluja, Saurabh LU ; Bergbrant, Sanna LU ; Olsson, Louise LU ; Björk, Jonas LU and Hagander, Lars LU orcid (2021) In European Journal of Pediatric Surgery 31(2). p.191-198
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 and Methods 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... (More)

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 and Methods 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.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
complications, laparoscopic, pediatric appendicitis, small bowel obstruction, surgical site infection
in
European Journal of Pediatric Surgery
volume
31
issue
2
pages
191 - 198
publisher
Georg Thieme Verlag
external identifiers
  • scopus:85088660665
  • pmid:32590867
ISSN
0939-7248
DOI
10.1055/s-0040-1712508
language
English
LU publication?
yes
id
95a0c8a1-0ccd-446a-a980-d7fdf02bd7ef
date added to LUP
2020-08-05 11:21:23
date last changed
2024-06-12 18:28:55
@article{95a0c8a1-0ccd-446a-a980-d7fdf02bd7ef,
  abstract     = {{<p>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 and Methods A nationwide retrospective cohort study of all Swedish children (&lt;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 &lt; 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 &lt; 0.001), readmission (5.5 vs. 1.2, aOR: 4.74 [95% CI: 4.08-5.53], p &lt; 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 &lt; 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.</p>}},
  author       = {{Omling, Erik and Salö, Martin and Saluja, Saurabh and Bergbrant, Sanna and Olsson, Louise and Björk, Jonas and Hagander, Lars}},
  issn         = {{0939-7248}},
  keywords     = {{complications; laparoscopic; pediatric appendicitis; small bowel obstruction; surgical site infection}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{191--198}},
  publisher    = {{Georg Thieme Verlag}},
  series       = {{European Journal of Pediatric Surgery}},
  title        = {{A Nationwide Cohort Study of Outcome after Pediatric Appendicitis}},
  url          = {{http://dx.doi.org/10.1055/s-0040-1712508}},
  doi          = {{10.1055/s-0040-1712508}},
  volume       = {{31}},
  year         = {{2021}},
}