Interval Appendectomy Improves Outcomes in Children with Complicated Appendicitis

Dennis W Vane, Nathanial Fernandez
University of Vermont College of Medicine, Burlington, VT

Objective: Ascertain optimal treatment for children with complicated appendicitis(CA)
Design: An inception cohort of children with documented CA was reviewed and criteria for interval appendectomy(IA) developed. Outcomes comparing immediate operation (IO) or IA were reviewed.
Setting: University Hospital
Patients: Children(21 days-17 yrs) with documented CA by CTscan.
Interventions: Children with CA were separated into two groups. Those presenting with symptoms <72 hours of CA or who appeared toxic and those presenting >72 hours who were not toxic. Group 1 underwent IO treated by criteria previously published. Group 2 was treated in hospital with triple antibiotics until afebrile, normal WBC, tolerating diet and adequate pain control. They were discharged on oral Flagyl or Flagyl & Bactrim for 6 weeks and then underwent IA.
Main Outcome Measures: Length of stay(LOS), morbidity and mortality.
Results: 86 children had CA, 59 IO and 27 IA. There was one wound infection and two intra-abdominal abscess (all IO). Preadmission symptoms were present for 9 days +/- 5 days in the IA group and 3 days +/- 3 days in the IO group. There was one death (IO newborn). LOS for the IO group was 4.9+/- 1.7 days and 4.1 days + .9 +/- .8 days for the IA group. One patient was treated off protocol in the IA group.
Conclusions: Treating select children with IA led to a decrease in length of stay and complications in this limited population. IA is a safe, cost effective and useful adjunct for the pediatric surgeon treating children with CA.

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