Outcomes after appendectomy in children with acute appendicitis treated at a tertiary paediatric centre: results from a retrospective cohort study

Abstract

Purpose In general, an appendectomy is presumed to have a limited burden of disease. However, in current literature, reported complication rates vary. This study aims to provide additional insights in the incidence of post-appendectomy complications in children with acute appendicitis. Methods This retrospective cohort study included children (0-17 years old) that underwent appendectomy at our tertiary referral centre for suspected acute appendicitis (January 2011-December 2018). Children referred to our centre, and those that underwent non-operative treatment were excluded. Post-appendectomy complications were recorded from electronic medical charts using predefined definitions and classified as severe (Clavien-Dindo III-IV) or less severe (Clavien-Dindo I-II). Results A total of 131 children were included. Simple and complex appendicitis was diagnosed in 66 (50%) and 60 (46%) children, respectively. A non-inflamed appendix was seen in five (4%) children. One or more complications were identified in 33 (25%) patients. Eight (12%) children with simple appendicitis developed a complication, three of these were severe. In children with complex appendicitis, 23 (38%) children developed a complication, 14 of these were severe. Conclusion This study shows a high rate of complications compared with current literature, both in children with simple and complex appendicitis. This is probably the result of our definition of complications and being a tertiary referral centre receiving more severe appendicitis cases. However, these results still show that appendectomy is not always a routine procedure with only few complications. Substantiating the need to keep optimizing treatment for children with appendicitis.

Post-operative Complications of Complicated Paediatric Appendicitis in a Tertiary Teaching Hospital

“…Mean hospital stay was 7.72 days. It is higher than that reported by Max Knaapen et al [11] (5.5days) but less than reported by Martin L. Blakely et al [10] (11.2 days).…”

“…They had 10.4% incidence of adhesive intestinal obstruction in interval appendicectomy. Max Knaapen et al [11] reports 15% intra-abdominal collection, they also had one stump leakage (1.6%) and one fistula (1.6%) out of 60 patients.…”

“…There was total of 601 children with complicated appendicitis, of which 40.6% were females and 59.4% were males. Francesco M. Labricciosa et al [9] Martin L. Blakely et al [10] and Max Knaapen et al [11] report similar male predominance of 3:2. The mean age in our study was 8.26 yrs which is less than that reported by Martin L. Blakely et al [10] (10.4yrs) and Max Knaapen et al [11] (10.5yrs).…”

“…Martin L. Blakely et al [10] reports 30% incidence of serious complications. Max Knaapen et al [11] reports 23% serious complications for complicated appendicitis. In our study commonest serious complication was intraabdominal abscess (9.2%) followed by adhesive intestinal obstruction (3.8%).…”

Complications after appendectomy in patients with treated appendicitis: results from a retrospective study

“…Complication severity was graded in accordance with the Clavien-Dindo classification system (11). Complications were also categorized as less severe (Clavien-Dindo I-II) or severe (Clavien-Dindo III-IV) (12). The most common complications after appendectomy included: surgical site infection (SSI), which was divided into superficial (inflammation in the skin or the subcutaneous tissue) or deep (inflammation in deep soft tissues of the incision, such as the muscles, fascia and tissue around it); ileus, which was defined as not resuming bowel movements within 5 days of the intervention; and IAA confirmed by CT scan or collection of pus in the abdomen.…”