A simple classification of peritoneal contamination in perforated appendicitis predicts surgery‐related complications

Abstract

Aim Perforated appendicitis has poorer clinical outcomes compared to non‐perforated appendicitis. However, accurate outcome comparisons in research and clinical audits are challenged by its wide spectrum of manifestation. Previous attempts at the classification of severity have been complex and difficult to reproduce. In our study, we used another institution's (Jones et al., TX, USA) previously described simple classification system of peritoneal contamination and examined its usefulness in predicting outcomes. Methods With ethical approval, we retrospectively reviewed the records of all paediatric patients operated at our institution for perforated appendicitis from 2016 to 2017. Patient demographics, intra‐operative and histological findings, post‐operative outcomes and length of stay were collected. Patients were categorised into group 1 (purulence in right lower quadrant only) and group 2 (contamination in two or more quadrants). Post‐operative complications were defined as procedure‐related (e.g. post‐operative ileus, intra‐abdominal abscess, visceral injury) and non‐procedure‐related (e.g. bronchospasm). Statistical analysis using χ2 tests for categorical data and Mann–Whitney U‐tests for non‐parametric continuous variables was performed, with a significance of P < 0.05. Results There were 134 eligible patients. We excluded 19 with incomplete data, leaving 115 for analysis, of which 69 (60%) were in group 2. Those in group 2 had a longer stay (P = 0.005) and more post‐operative complications (P = 0.001), particularly procedure‐related events (P = 0.006). There were no differences in age (P = 0.182), gender (P = 0.876), readmission rate (P = 0.317) and non‐procedure‐related post‐operative complications (0.152). Conclusion This simple classification of perforated appendicitis appears to differentiate clinical outcomes well, particularly for iatrogenic morbidity, making it useful for operative preparation and outcomes research.

Complicated acute appendicitis in children: the importance of stewarding antibiotic prescriptions

“…This was more evidence of how the extension of the infection could be determinant in the workload of the postoperative management of CAAs, confirming the findings reported by Feng et al 5 Pediatric CAAs might present a heterogeneous spectrum of severity, that might not be preoperatively predicted by blood tests or clinical variables. 4,5 However, in our series, the age of the children affected by ECA was sensibly lower. This was consistent with the previous literature, as younger children with acute appendicitis were more prone to present with more extended abdominal infections.…”

“…Indeed, the abdominal drain might have been used for the worst ECAs that presented a higher risk of complications. 4,5 As to the potential factors associated with the failure of the standard regimen, several aspects were investigated. Nevertheless, the only significant variable turned out to be the severity of the abdominal contamination.…”

“…As previously reported in the literature, CAAs were categorized as localized complicated appendicitis (LCA) or extensively complicated appendicitis (ECA). [4][5][6] The ECA subgroup was characterized by the involvement of two or more abdominal quadrants in the infectious process.…”

“…It is crucial to formulate the correct diagnosis and to describe the extension of peritoneal contamination because CAAs are associated with worse clinical outcomes, higher rates of complications and higher costs. 4,5 Recently, the number of abdominal quadrants involved in the infectious process has been described as a predictor of the outcome. 6 Furthermore, CAAs required a more demanding antibiotic therapy to control the source of infection.…”

Investigation of Serum Interleukin 6, High-Sensitivity C-Reactive Protein and White Blood Cell Levels during the Diagnosis and Treatment of Paediatric Appendicitis Patients Before and during the COVID-19 Pandemic

“…The development of surgical complications after appendicitis surgery in patients is a rare but important condition. [ 14 , 15 ] Clinical evaluation alone may be inadequate, especially in perforated appendicitis patients with peritonitis. [ 14 , 15 ] Therefore, knowing when the laboratory parameters return to normal values might be useful for the diagnosis and treatment of those complications.…”