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01-11-2018 | Original Scientific Report

Pediatric Appendicitis Severity in KwaZulu-Natal, South Africa: A Retrospective Cohort Analysis

Authors: Matthew C. Hernandez, Victor Y. Kong, John L. Bruce, Johnathon M. Aho, Grant L. Laing, Martin D. Zielinski, Damian L. Clarke

Published in: World Journal of Surgery | Issue 11/2018

Abstract

Background

Acute appendicitis is a common pediatric surgical emergency; however, there are few grading systems to assign disease severity. The American Association for the Surgery of Trauma (AAST) recently developed a grading system for a variety of emergency surgical conditions, including appendicitis. The severity of acute appendicitis in younger patients in KwaZulu-Natal (South Africa) is unknown. We aimed to describe the disease severity in this patient population using the AAST grading system hypothesizing that the AAST grade would correlate with morbidity, management type, and duration of stay.

Materials

Single institutional review of patients <18 years old with a final diagnosis of acute appendicitis during 2010–2016 in KwaZulu-Natal, South Africa, was performed. Demographics, physiologic and symptom data, procedural details, postoperative complications, and Clavien–Dindo classification were abstracted. AAST grades were generated based on intraoperative findings. Summary, univariate, and nominal logistic regression analyses were performed to compare AAST grade and outcomes.

Results

A total of 401 patients were identified with median [IQR] age of 11 [5–13], 65% male. Appendectomy was performed in all patients; 2.4% laparoscopic, 37.6% limited incision, and 60% midline laparotomy. Complications occurred in 41.6%, most commonly unplanned relaparotomy (22.4%), surgical site infection (8.9%), pneumonia (7.2%), and acute renal failure (2.9%). Complication rate and median length of stay increased with greater AAST grade (all p < 0.001). AAST grade was independently associated with increased risk of complications.

Conclusion

Pediatric appendicitis is a morbid disease in a developing middle-income country. The AAST grading system is generalizable and accurately corresponds with management strategies as well as key clinical outcomes.

Level of evidence

Retrospective study, Level IV.

Study type

Retrospective single institutional study.

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Title: Pediatric Appendicitis Severity in KwaZulu-Natal, South Africa: A Retrospective Cohort Analysis
Authors: Matthew C. Hernandez
Victor Y. Kong
John L. Bruce
Johnathon M. Aho
Grant L. Laing
Martin D. Zielinski
Damian L. Clarke
Publication date: 01-11-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 11/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4677-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pediatric Appendicitis Severity in KwaZulu-Natal, South Africa: A Retrospective Cohort Analysis

Abstract

Background

Materials

Results

Conclusion

Level of evidence

Study type

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials

Results

Conclusion

Level of evidence

Study type

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