Pediatric Appendicitis Can Be Safely Managed as an Urgent, Rather than Emergent, Procedure

The time to appendectomy, if performed within 24 hours of presentation, was

not associated with perforation or other complications.

appendectomy may result in complications (perforation) and prolonged

hospital stay. Using the Pediatric National Surgical Quality Improvement

Program database, researchers examined time to appendectomy (TTA) and its

association with complications for 2429 children (age <18 years) who had

appendectomies within 24 hours of emergency department (ED) admission in

2013 and 2014. Patients who were evaluated and then referred and those who

had a computed tomography scan prior to appendectomy were excluded.

The median TTA (time from ED registration to skin incision) for all 23 hospitals

was 7.4 hours (range, 5.0 to 19.2 hours). Overall, 23.6% of patients had

complicated appendicitis. In multivariable analysis, increased risk for

complicated appendicitis was associated with age <7 years, female sex, and

Hispanic ethnicity. Longer TTA was not associated with increased risk for

complications or adverse postoperative events (e.g., surgical site infections).

However, the longer the TTA, the longer the length of stay, with each 1-hour

delay translating to a 1.4-hour longer stay. Within each hospital, a TTA longer

than that hospital’s median was not associated with adverse postoperative events.