Our Summary

This research paper looks at the outcomes of two different approaches to treating children with a specific type of appendicitis, known as perforated appendicitis. One approach is to first manage the condition conservatively (without surgery), then readmit the patient for surgery to remove the appendix at a later date. The other approach is to perform the surgery during the same hospital admission as when the appendicitis was diagnosed.

The study analyzed national data from 2010-2014 and found that only 1% of pediatric patients with perforated appendicitis were readmitted for surgery at a later date, while 99% had the surgery during the same hospital stay.

Those who were readmitted for surgery were more likely to have a laparoscopic operation (a less invasive type of surgery), but they were also more likely to have their laparoscopic procedure converted to an open surgery (a more invasive type of surgery). They also had more additional procedures performed.

The analysis showed that those who had their appendix removed during the same hospital stay had a higher rate of a specific complication, small bowel obstruction. However, all other complications were similar between the two groups.

Although those who were readmitted for surgery had a shorter hospital stay and lower costs for that stay, they ended up paying an extra $8044 on average because of the cost of their prior admission.

In conclusion, the researchers found that patients who were readmitted for surgery had more additional procedures and higher total hospital costs, but the rates of postoperative complications were similar to those who had surgery during the same hospital stay.

FAQs

  1. What is the comparison between the outcomes of interval and same-admission appendectomy in children with perforated appendicitis?
  2. What are the differences in postoperative outcomes for children who received interval appendectomy compared to those who received same-admission appendectomy?
  3. Are there cost differences between interval appendectomy and same-admission appendectomy for pediatric patients with perforated appendicitis?

Doctor’s Tip

One helpful tip a doctor might tell a patient about pediatric appendectomy is to follow the recommended postoperative care instructions closely to ensure proper healing and reduce the risk of complications. This may include taking prescribed medications, maintaining good hygiene, avoiding strenuous activities, and attending follow-up appointments as scheduled. It is also important to contact your healthcare provider if you experience any concerning symptoms or changes in your condition.

Suitable For

Pediatric patients with perforated appendicitis who have undergone conservative management and have had a prior admission for perforated appendicitis within one calendar year are typically recommended for interval appendectomy. These patients may benefit from this approach in terms of shorter index length of stay and lower admission costs, despite incurring higher combined hospitalization costs and potentially more concomitant procedures compared to those receiving same-admission appendectomy.

Timeline

  • Patient presents with symptoms of appendicitis such as abdominal pain, nausea, vomiting, and fever
  • Patient undergoes diagnostic tests such as physical examination, blood tests, and imaging studies (CT scan or ultrasound)
  • Pediatric surgeon recommends appendectomy for perforated appendicitis
  • Patient is admitted to the hospital for surgery
  • Patient undergoes laparoscopic or open appendectomy procedure
  • Patient may have concomitant procedures during surgery
  • Patient may experience complications such as small bowel obstruction
  • Patient has a shorter length of stay and lower admission costs with interval appendectomy compared to same-admission appendectomy
  • Patient incurs additional costs from prior admission for interval appendectomy
  • Patient has a similar postoperative complication profile with both types of appendectomy procedures.

What to Ask Your Doctor

  1. What are the risks and benefits of undergoing an interval appendectomy versus a same-admission appendectomy for perforated appendicitis in children?
  2. What factors should be considered when deciding between interval and same-admission appendectomy for my child?
  3. How does the length of hospital stay and cost differ between interval and same-admission appendectomy procedures?
  4. What is the likelihood of needing additional procedures or complications following an interval appendectomy compared to a same-admission appendectomy?
  5. How does the type of surgical approach (laparoscopic versus open) impact outcomes for pediatric patients undergoing appendectomy for perforated appendicitis?
  6. Are there any long-term considerations or implications for choosing an interval appendectomy over a same-admission appendectomy for my child’s condition?
  7. What is the recovery process like for children undergoing an interval appendectomy versus a same-admission appendectomy for perforated appendicitis?

Reference

Authors: Huerta CT, Courel SC, Ramsey WA, Saberi RA, Gilna GP, Ribieras AJ, Parreco JP, Thorson CM, Sola JE, Perez EA. Journal: J Pediatr Surg. 2023 Apr;58(4):651-657. doi: 10.1016/j.jpedsurg.2022.12.009. Epub 2022 Dec 22. PMID: 36641313