M. C. Hernandez1, S. F. Polites1, J. M. Aho1, V. Y. Kong2, D. Clarke2, M. Zielinski1 1Mayo Clinic,Department Of Surgery,Rochester, MN, USA 2Pietermaritzburg Metropolitan Complex,Department Of Surgery,Durban, KWA-ZULU, South Africa
Introduction:
Acute appendicitis is the most common emergent pediatric surgical condition but lacks a standard classification for disease severity. The American Association for the Surgery of Trauma (AAST) developed an emergency general surgery grading system for various diseases including appendicitis. We aim to determine if the AAST grading system is valid in a heterogeneous, pediatric population in Minnesota, USA and KwalaZulu Province, South Africa.
Methods:
Retrospective review of electronic databases for patients <18 years old with acute appendicitis presenting during 2008 to 2016 was performed. Basic demographics, preoperative physiologic and symptom data, procedure details, postoperative complications based upon NSQIP and Clavien-Dindo classification were recorded. AAST grades were generated based upon intraoperative findings. Summary statistical univariate and nominal logistic regression analyses were performed to compare AAST grade and outcomes.
Results:
A total of 732 patients were identified with median [IQR] age of 11 [9-13], 59% male. Appendectomy was performed in all patients; 57.9% laparoscopic, 25.1% McBurney incision, and 17% midline laparotomy. Increasing AAST grade was associated with increasing incidence of complication severity as described by Clavien Dindo, p=0.001. The most frequent complications were surgical site infection (7.9%), abscess formation (4.5%), pneumonia (4.3%), and acute renal failure (1.7%). Patients with postoperative complications had greater median [IQR] AAST grades than those without, (4 [2-5] vs 1 [1-2], p=0.001). Median length of stay was increased for patients with higher AAST grade (V vs I) (10 vs 1 days, p=0.001). Nominal logistic regression identified the following predictors of any complication included (p<0.05): AAST grade, preoperative duration of symptoms, and initial temperature.
Conclusion:
The AAST appendicitis grading system is valid in a multinational pediatric population and increased grade is associated with patient outcomes. Increasing grade is associated with increased risk for complication. Preoperative imaging warrants validation with operative findings.
