M. M. Hodges1, S. N. Acker2, E. E. Moore3, A. Schubert4, L. R. Hill2, D. A. Partrick2, D. Bensard2,3 1University Of Colorado Denver,Laboratory For Fetal And Reproductive Biology, Division Of Pediatric Surgery, Department Of General Surgery,Aurora, CO, USA 2Children’s Hospital Colorado,Department Of Pediatric Surgery, University Of Colorado School Of Medicine,Aurora, CO, USA 3Denver Health Medical Center,Department Of General Surgery,Aurora, CO, USA 4University Of Colorado Denver,Anschutz Medical Campus,Aurora, CO, USA
Introduction: Acute appendicitis is the most common emergent surgical procedure performed among children in the US, with an incidence exceeding 70,000 cases per year. In large urban centers, appendectomies are often performed by both pediatric surgeons and adult trauma and acute care surgeons (TACS surgeons). We hypothesized that children undergoing appendectomy for acute appendicitis have equivalent outcomes whether a pediatric surgeon or a TACS surgeon performs the operation. To evaluate our hypothesis we analyzed the outcomes of pediatric appendectomy performed by three populations of surgeons; pediatric surgeons operating in a pediatric, tertiary referral center; pediatric surgeons operating in an urban safety-net hospital; and adult TACS surgeons operating in an urban safety-net hospital.
Methods: A retrospective chart review was performed for all patients under 18 years of age, who underwent appendectomy at either a tertiary care children’s hospital (group A, n=100) or an urban safety net hospital between July 2010 and June 2015. The population of patients operated upon at the safety net hospital was further subdivided into those operated upon by pediatric surgeons (group B, n=60) and those operated upon by adult TACS surgeons (group C, n=60). Baseline characteristics and operative outcomes were compared between these three patient populations utilizing one-way analysis of variance (ANOVA) and Chi-squared test for independence.
Results: When comparing the three populations, we found no difference in either the proportion of patients with complicated appendicitis (p=0.05), operative time (p=0.18), postoperative length of stay (p=0.14), rate of infectious complications (p=0.41), or rate of readmission (p=0.50). The three study populations did differ with regard to the mean age of the patients operated upon (group A 9.4±3.6 years [mean± SD], group B 8.3±3.6 years, and group C 12.4±3.6 years; p <0.0005); however, this can be attributed to protocol at the urban safety net hospital requiring patients less than 5 years old be treated by pediatric surgeons. Time from assessment in emergency department to operating room was also longer for patients in group B (13.1±11.0 hours versus 9.8±8.6 hours in group A and 8.3±3.3 hours in group C, p=0.006), and there was a higher rate of open appendectomy among children operated on by both pediatric surgeons and TACS surgeons at the urban safety net hospital versus the children’s hospital (30% in group B and 23.3% in group C versus 3.1% in group A, p <0.0005).
Conclusion: Our data demonstrate that among children undergoing appendectomy, length of stay, risk of infectious complications, and risk of readmission do not differ regardless of whether they are operated upon by pediatric surgeons or adult TACS surgeons, suggesting resources currently consumed by transferring children to hospitals with access to pediatric surgeons could be allocated elsewhere.