A. Hu1, S. Becker2, D. Kulasekere2, R. Mathur1, G. Sullivan1, A. Reiter1, C. DeBoer1, Y. Tian1, S. D. Goldstein1, M. V. Raval1 1Ann & Robert H Lurie Children’s, Pediatric Surgery, Chicago, IL, USA 2Feinberg School Of Medicine – Northwestern University, Chicago, IL, USA
Introduction:
Perforated appendicitis in children is common and associated with significant morbidity. Since 2010, several studies have demonstrated that early appendectomy is associated with improved outcomes compared with initial nonoperative management and interval appendectomy. Despite these data, the uptake of this evidence-based practice remains unclear. This study aims to assess the trend in evidence-based early operative management for perforated appendicitis patients at a single center.
Methods:
A retrospective cohort study of children ≤ 18 years of age with acute appendicitis was conducted spanning 1/1/2010 through 12/31/2020 at a single U.S. children’s hospital. Patients were identified using ICD-9 and ICD-10 codes, and manual chart review was performed. Patients were stratified, based upon the diagnosis of perforation in the preoperative setting, into 3 separate categories: 1) not perforated 2) suspicious for perforation 3) perforated. Our main outcome was the use of early operative management. We excluded patients who were immunosuppressed at diagnosis, treated at an outside hospital, or initially managed for an alternate pathology. Annual rates of early operative intervention and temporal trends were analyzed using a univariate logistic regression where year of admission served as a continuous variable.
Results:
We identified 3679 patients diagnosed with appendicitis at our institution within the study period of which 91 were excluded and 3603 underwent analysis. Of the analysis cohort, 2159 (60.1%) were male, the average age at diagnosis was 9.8 years (SD 3.8 years), and 2113 (58.8%) were Hispanic white. The average number of patients was 326.4 patients per year (SD 62.4 patients). There were 2985 (83.2%) non-perforated patients with an average of 271.4 (SD 43.7 patients) per year and 240 (6.7%) patients with suspected perforation with an average of 21.8 (SD 11.8 patients) patients per year. Of the 365 (10.2%) perforated patients, the average number of patients per year was 33.2 (SD 3.1 patients). Annual rates of early operative management ranged from 33.3% to 84.8%. The annual rate of early operative management was 43.4% in 2010 and 80.3% in 2020 with an overall upward (OR = 1.2, CI [1.11 – 1.28], p < 0.01) (Figure).
Conclusion:
Early operative management in perforated appendicitis has slowly increased between 2010 and 2020 indicating the uptake of evidence-based practice. Drivers to implement and accelerate adoption of evidence-based practices such as institution of clinical practice guidelines warrant future investigation.
