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Open Access 01-02-2021 | Appendicitis | Original Article

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

Authors: Max Knaapen, Paul van Amstel, Tim van Amstel, Sarah-May M. L. The, Roel Bakx, Ernest L. W. E. van Heurn, Ramon R. Gorter

Published in: Langenbeck's Archives of Surgery | Issue 1/2021

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.

Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925. https://doi.org/10.1093/oxfordjournals.aje.a115734CrossRefPubMed

Bhangu A, Søreide K, Di Saverio S et al (2015) Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet 386:1278–1287. https://doi.org/10.1016/S0140-6736(15)00275-5CrossRefPubMed

Cameron DB, Anandalwar SP, Graham DA, Melvin P, Serres SK, Dunlap JL, Kashtan M, Hall M, Saito JM, Barnhart DC, Kenney BD, Rangel SJ (2018) Development and implications of an evidence-based and public health-relevant definition of complicated appendicitis in children. Ann Surg 1, 271:–968. https://doi.org/10.1097/SLA.0000000000003059

Bolmers MD, van Rossem CC, Gorter RR et al (2018) Imaging in pediatric appendicitis is key to a low normal appendix percentage: a national audit on the outcome of appendectomy for appendicitis in children. Pediatr Surg Int 34:543–551. https://doi.org/10.1007/s00383-018-4244-2CrossRefPubMedPubMedCentral

Gorter RR, Eker HH, Gorter-Stam MAW, Abis GSA, Acharya A, Ankersmit M, Antoniou SA, Arolfo S, Babic B, Boni L, Bruntink M, van Dam DA, Defoort B, Deijen CL, DeLacy FB, Go PMNYH, Harmsen AMK, van den Helder RS, Iordache F, Ket JCF, Muysoms FE, Ozmen MM, Papoulas M, Rhodes M, Straatman J, Tenhagen M, Turrado V, Vereczkei A, Vilallonga R, Deelder JD, Bonjer J (2016) Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc 30:4668–4690. https://doi.org/10.1007/s00464-016-5245-7CrossRefPubMedPubMedCentral

Cameron DB, Williams R, Geng Y, Gosain A, Arnold MA, Guner YS, Blakely ML, Downard CD, Goldin AB, Grabowski J, Lal DR, Dasgupta R, Baird R, Gates RL, Shelton J, Jancelewicz T, Rangel SJ, Austin MT (2018) Time to appendectomy for acute appendicitis: a systematic review. J Pediatr Surg 53:396–405. https://doi.org/10.1016/j.jpedsurg.2017.11.042CrossRefPubMed

Tiboni S, Bhangu A, Hall NJ, Paediatric Surgery Trainees Research Network and the National Surgical Research Collaborative (2014) Outcome of appendicectomy in children performed in paediatric surgery units compared with general surgery units. Br J Surg 101:707–714. https://doi.org/10.1002/bjs.9455CrossRefPubMed

Markar SR, Blackburn S, Cobb R, Karthikesalingam A, Evans J, Kinross J, Faiz O (2012) Laparoscopic versus open appendectomy for complicated and uncomplicated appendicitis in children. J Gastrointest Surg 16:1993–2004. https://doi.org/10.1007/s11605-012-1962-yCrossRefPubMed

Fujishiro J, Watanabe E, Hirahara N, Terui K, Tomita H, Ishimaru T, Miyata H (2020) Laparoscopic versus open appendectomy for acute appendicitis in children: a nationwide retrospective study on postoperative outcomes. J Gastrointest Surg:1–9. https://doi.org/10.1007/s11605-020-04544-3

10.

Jason Fisher (2016) Comparison of medical and surgical treatment of uncomplicated acute appendicitis in children - ClinicalTrials.gov. In: Last Updat. December 9, 2016

11.

Xu J, Liu YC, Adams S, Karpelowsky J (2016) Acute uncomplicated appendicitis study: rationale and protocol for a multicentre, prospective randomised controlled non-inferiority study to evaluate the safety and effectiveness of non-operative management in children with acute uncomplicated appendiciti. BMJ Open 6:e013299. https://doi.org/10.1136/bmjopen-2016-013299CrossRefPubMedPubMedCentral

12.

Knaapen M, van der Lee JH, Bakx R et al (2017) Initial non-operative management of uncomplicated appendicitis in children: a protocol for a multicentre randomised controlled trial (APAC trial). BMJ Open 7:e018145. https://doi.org/10.1136/bmjopen-2017-018145CrossRefPubMedPubMedCentral

13.

Hall NJ, Eaton S, Abbo O et al (2017) Appendectomy versus non-operative treatment for acute uncomplicated appendicitis in children: study protocol for a multicentre, open-label, non-inferiority, randomised controlled trial. BMJ Paediatr Open 1:e000028CrossRef

14.

Simillis C, Symeonides P, Shorthouse AJ, Tekkis PP (2010) A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery 147:818–829. https://doi.org/10.1016/j.surg.2009.11.013CrossRefPubMed

15.

Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 20:271–274CrossRefPubMed

16.

van Rossem CC, Bolmers MDM, Schreinemacher MHF, van Geloven AAW, Bemelman WA, the Snapshot Appendicitis Collaborative Study Group (2016) Prospective nationwide outcome audit of surgery for suspected acute appendicitis. Br J Surg 103:144–151. https://doi.org/10.1002/bjs.9964CrossRefPubMed

17.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2CrossRefPubMed

18.

Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.aeCrossRefPubMedPubMedCentral

19.

Masoomi H, Nguyen NT, Dolich MO, Mills S, Carmichael JC, Stamos MJ (2014) Laparoscopic appendectomy trends and outcomes in the United States: data from the Nationwide Inpatient Sample (NIS), 2004-2011. Am Surg 80:1074–1077CrossRefPubMed

20.

Georgiou R, Eaton S, Stanton MP, Pierro A, Hall NJ (2017) Efficacy and safety of nonoperative treatment for acute appendicitis: a meta-analysis. Pediatrics 139:e20163003. https://doi.org/10.1542/peds.2016-3003CrossRefPubMed

21.

Knaapen M, Hall NJ, van der Lee JH et al (2019) Establishing a core outcome set for treatment of uncomplicated appendicitis in children: study protocol for an international Delphi survey. BMJ Open 9(5):e028861. https://doi.org/10.1136/bmjopen-2018-028861CrossRefPubMedPubMedCentral

22.

Salminen P, Tuominen R, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T, Hurme S, Mecklin JP, Sand J, Virtanen J, Jartti A, Grönroos JM (2018) Five-year follow-up of antibiotic therapy for uncomplicated acute appendicitis in the APPAC Randomized Clinical Trial. JAMA 320:1259–1265. https://doi.org/10.1001/jama.2018.13201CrossRefPubMedPubMedCentral

23.

Rollins KE, Varadhan KK, Neal KR, Lobo DN (2016) Antibiotics versus appendicectomy for the treatment of uncomplicated acute appendicitis: an updated meta-analysis of randomised controlled trials. World J Surg 40:2305–2318. https://doi.org/10.1007/s00268-016-3561-7CrossRefPubMed

24.

Harnoss JC, Zelienka I, Probst P, Grummich K, Müller-Lantzsch C, Harnoss JM, Ulrich A, Büchler MW, Diener MK (2017) Antibiotics versus surgical therapy for uncomplicated appendicitis: systematic review and meta-analysis of controlled trials. Ann Surg. 265(5):889–900. https://doi.org/10.1097/SLA.0000000000002039CrossRefPubMed

25.

Huang L, Yin Y, Yang L, Wang C, Li Y, Zhou Z (2017) Comparison of antibiotic therapy and appendectomy for acute uncomplicated appendicitis in children: a meta-analysis. JAMA Pediatr. 171(5):426–434. https://doi.org/10.1001/jamapediatrics.2017.0057CrossRefPubMedPubMedCentral

26.

Kessler U, Mosbahi S, Walker B, et al. Conservative treatment versus surgery for uncomplicated appendicitis in children: a systematic review and meta-analysis. Arch Dis Child. 2017;archdischild-2017-313127. 10.1136/archdischild-2017-313127.

27.

Vaos G, Dimopoulou A, Gkioka E, Zavras N (2018) Immediate surgery or conservative treatment for complicated acute appendicitis in children? A meta-analysis. J Pediatr Surg. 54:1365–1371. https://doi.org/10.1016/j.jpedsurg.2018.07.017CrossRefPubMed

28.

Lee SL, Yaghoubian A, Kaji A (2011) Laparoscopic vs open appendectomy in children: outcomes comparison based on age, sex, and perforation status. Arch Surg 146:1118–1121. https://doi.org/10.1001/archsurg.2011.144CrossRefPubMed

29.

Jen HC, Shew SB (2010) Laparoscopic versus open appendectomy in children: outcomes comparison based on a statewide analysis. J Surg Res 161:13–17. https://doi.org/10.1016/j.jss.2009.06.033CrossRefPubMed

30.

Horvath P, Lange J, Bachmann R, Struller F, Königsrainer A, Zdichavsky M (2017) Comparison of clinical outcome of laparoscopic versus open appendectomy for complicated appendicitis. Surg Endosc 31:199–205. https://doi.org/10.1007/s00464-016-4957-zCrossRefPubMed

Title: Outcomes after appendectomy in children with acute appendicitis treated at a tertiary paediatric centre: results from a retrospective cohort study
Authors: Max Knaapen
Paul van Amstel
Tim van Amstel
Sarah-May M. L. The
Roel Bakx
Ernest L. W. E. van Heurn
Ramon R. Gorter
Publication date: 01-02-2021
Publisher: Springer Berlin Heidelberg
Keywords: Appendicitis
Appendicitis
Appendectomy
Published in: Langenbeck's Archives of Surgery / Issue 1/2021
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-020-01976-y

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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