Changes in Incidence and Management of Acute Appendicitis in Children—A Population-Based Study in the Period 2000–2015

Abstract

Introduction Recent studies suggest that the epidemiology and management of appendicitis have changed during the last decades. The purpose of this population-based study was to examine this in the pediatric population in Denmark. Materials and Methods Data were retrieved from the Danish National Patient Registry, the Danish Civil Registration System, and the Statbank Denmark. Patients aged 0 to 17 years diagnosed with appendicitis and appendectomized during the period 2000 to 2015 were included. The primary outcome was the annual incidences of appendicitis. Secondary outcomes were the annual percent of patients with appendicitis having a laparoscopic appendectomy, delay from admission to surgery, length of postoperative hospital stay, and 30-day postoperative mortality. Results A total of 24,046 pediatric cases of appendicitis were identified. The annual incidence steadily declined until 2008 (–29%, all ages) and then remained stable. The surgical approach of choice changed from being open appendectomy in 2000 (97%) to laparoscopic appendectomy in 2015 (94%). Simultaneously, the duration of postoperative hospital stay declined from 41 hours (median) to 17 hours. Delay from admission until surgery did not change during the period. Only one child died within the 30-day postoperative period. Conclusion In accordance with other recent studies from Western countries, we found significant changes in the incidence of acute appendicitis including a decline in all age groups except those below 5 years of age, a shift toward laparoscopic appendectomy, and decreasing time spent in the hospital during the years 2000 to 2015.

Incidence of appendicitis during COVID-19 lockdown: A nationwide population-based study

“…27 A previous Danish study showed that the normal median therapeutic delay from admission to surgery is 5-7 h for patients with appendicitis. 28 Based on this, it does not seem plausible that the lower incidence of complicated appendicitis in our study was caused by a decreased therapeutic delay from admission to surgery for patients with appendicitis.…”

Validity of the coding for appendicitis, appendectomy, and diagnostic laparoscopy in the Danish National Patient Registry

“…We found a very good PPV for laparoscopic appendectomy of 99% (95% CI, 97%–99%), which has become the dominating surgical approach for both adults 16 and children 17 in Denmark. This is in line with the results of two previous Danish validation studies on the surgical approach for appendectomy.…”

“…However, the operative report provides insight into the course of treatment chosen by the operating surgeon. In Denmark, the median length of stay is 16 h and 17 h for adults 16 and children, 17 respectively. Therefore, the histopathology report will not affect the treatment course as this is typically not completed until days after the operation when the patients have already been discharged.…”

Diagnostic Value of Clinical Prediction Scores for Acute Appendicitis in Children Younger than 4 Years

“…A very recent study reports a significant change in the incidence of acute appendicitis including a decline in all age groups except those younger than 5 years. 40 A reliable predictive score for acute appendicitis in children younger than 4 years would help reduce delays in appendicectomy with the associated high risk of appendiceal perforation while reducing the need for invasive diagnostic procedures. 41…”