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Risk Factors for the Development of Abdominal Abscess Following Operation for Perforated Appendicitis: a Multi-Center Case Control Study

Marion C. W. Henry1, Angela Walker1, Bonnie L Silverman1, Gerald Gollin2, Saleem Islam3, Karl Sylvester4, R. Lawrence Moss1
1Yale University School of Medicine, New Haven, CT;2Loma Linda University School of Medicine, Loma Linda, CA;3University of Mississippi School of Medicine, Jackson, MS;4Stanford University School of Medicine, Stanford, CA

Objective To determine risk factors for developing a post-operative abscess after perforated appendicitis.
Design: Case control
Setting: 4 academic hospitals
Patients: all children with perforated appendicitis 1998-2003.
Cases: post-operative abscess.
Controls: no abscess.
Main outcome measures: Chi-square and Student’s t-test analyzed risks for abscess development. Factors with p-value <0.2 included in multivariate regression. ¾ of dataset used for model development, ¼ used to test model. Separate analysis of patients afebrile and tolerating a diet on post-operative day 3.
Results: 35 of 265 (13.2%) children developed an abscess. Ten factors with a p<0.2 included in the regression model. The multivariable model revealed 2 factors influencing abscess development: Diarrhea at presentation, OR 3.63 (95% CI: 1.29-10.21) and intraoperative fecalith, OR 8.77 (95% CI: 1.50-51.40).
Many factors proposed to be associated with abscess were not, including: pain history, type and timing of pre-operative antibiotics, abscess at operation, laparoscopic procedure, and length of antibiotics.
37 children were discharged on or before day 3. 21 children were afebrile and tolerating a diet at that time, but remained in the hospital. Of the 37 discharged early, 76% underwent laparoscopic appendectomy versus 38% of the others, p=0.008. None of the early discharge group developed an abscess, 2 of those remaining hospitalized did, p=0.06.
Conclusions: Clinical factors commonly thought to be predictive of abscess formation following perforated appendicitis were not reliable predictors of this outcome. Our results suggest that if children are afebrile and eating on POD#3, they can be discharged with a low rate of abscess development.

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