Pediatric appendicitis: Is referral to a regional pediatric center necessary?

AbstractBackgroundAcute appendicitis is the most common emergent surgical procedure performed among children in the US, with an incidence exceeding 80,000 cases per year. Appendectomies are often performed by both pediatric surgeons and adult general/trauma acute care surgeons (TACS surgeons). We hypothesized that children undergoing appendectomy for acute appendicitis have equivalent outcomes whether a pediatric surgeon or a TACS surgeon performs the operation.MethodsA retrospective chart review was performed for patients 6-18 years of age, who underwent appendectomy at either a regional children’s hospital (CHCO, n=241) or an urban safety net hospital (n=347) between July 2010 and June 2015. The population of patients operated upon at the urban safety net hospital was further subdivided into those operated upon by pediatric surgeons (DHMC Peds, n=68) and those operated upon by adult TACS surgeons (DHMC TACS, n=279). Baseline characteristics and operative outcomes were compared between these patient populations utilizing one-way analysis of variance (ANOVA) and Chi-squared test for independence.ResultsWhen comparing the CHCO and DHMC TACS groups, there were no differences in the proportion of patients with perforated appendicitis, operative time, rate of operative complications, rate of postoperative infectious complications, or rate of 30-day readmission. Length of stay was significantly shorter for the DHMC TACS group than the CHCO group.ConclusionOur data demonstrate that among children >5yo undergoing appendectomy, length of stay, risk of infectious complications, and risk of readmission do not differ regardless of whether they are operated upon by pediatric surgeons or adult TACS surgeons, suggesting resources currently consumed by transferring children to hospitals with access to pediatric surgeons could be allocated elsewhere.Level of evidenceLevel III, economic/decision Background Acute appendicitis is the most common emergent surgical procedure performed among children in the US, with an incidence exceeding 80,000 cases per year. Appendectomies are often performed by both pediatric surgeons and adult general/trauma acute care surgeons (TACS surgeons). We hypothesized that children undergoing appendectomy for acute appendicitis have equivalent outcomes whether a pediatric surgeon or a TACS surgeon performs the operation. Methods A retrospective chart review was performed for patients 6-18 years of age, who underwent appendectomy at either a regional children’s hospital (CHCO, n=241) or an urban safety net hospital (n=347) between July 2010 and June 2015. The population of patients operated upon at the urban safety net hospital was further subdivided into those operated upon by pediatric surgeons (DHMC Peds, n=68) and those operated upon by adult TACS surgeons (DHMC TACS, n=279). Baseline characteristics and operative outcomes were compared between these patient populations utilizing one-way analysis of variance (ANOVA) and Chi-squared test for independence. Results When comparing the CHCO and DHMC TACS groups, there were no differences in the proportion of patients with perforated appendicitis, operative time, rate of operative complications, rate of postoperative infectious complications, or rate of 30-day readmission. Length of stay was significantly shorter for the DHMC TACS group than the CHCO group. Conclusion Our data demonstrate that among children >5yo undergoing appendectomy, length of stay, risk of infectious complications, and risk of readmission do not differ regardless of whether they are operated upon by pediatric surgeons or adult TACS surgeons, suggesting resources currently consumed by transferring children to hospitals with access to pediatric surgeons could be allocated elsewhere. Level of evidence Level III, economic/decision Conflicts of Interest and Source of Funding: The authors have no conflicts of interest nor sources of funding to disclose. Correspondence: Maggie M. Hodges, MD, MPH, Department of Surgery, University of Colorado Denver - Anschutz Medical Campus, Children’s Hospital Colorado, 12700 E. 19th Ave, Aurora, CO 80045. Email: maggie.hodges@ucdenver.edu, Phone: 303-724-4186 © 2017 Lippincott Williams & Wilkins, Inc.

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