A. A. Shah1,3, A. Badillo3, P. Guzzetta3, T. Kane3, A. Sandler3, M. Petrosyan2,3 1Howard University College Of Medicine,Surgery,Washington, DC, USA 2George Washington University School Of Medicine And Health Sciences,Surgery,Washington, DC, USA 3Children’s National Medical Center,Surgery,Washington, DC, USA
Introduction: A majority of adolescent patients with appendicitis initially present to hospitals that do not uniquely care for children. The initial treatment is frequently by general surgeons. This study aims to examine the differences in outcomes in such patients when treated by either a pediatric or general surgeon.
Methods: The 2012-2013 American College of Surgeons Pediatric NSQIP was queried for adolescent patients(age>10) undergoing a laparoscopic appendectomy. Patients with an operative-time greater than the 75% percentile of the average operative-time were excluded. The population was subdivided into those treated by general surgeons and those treated by pediatric subspecialists. Propensity-score matching was utilized to match across baseline parameters such as age, race/ethnicity and sex prior to multivariable logistic and linear regression analysis. Outcomes of interest were operative-time, total length of hospital stay (LOS), complications, unplanned readmission, reoperation, and conversion to open.
Results: Of 7,272 laparoscopic appendectomies, 238 were performed by general surgeons. 60.2% were males and the average age was 12.9(+2.4)years. General surgeons treated slightly older patients (14.0y vs 12.8y,p<0.05). Median operative-time was 38(IQR: 29-46)minutes. Median LOS was 1(IQR: 1-2)days. Rates of complications, unplanned readmissions, reoperations and conversion to open were 3.0%, 3.0%, 0.8% and 3.4%, respectively. Matched multivariable regression analysis revealed no differences (Table) in operative-times, LOS, complications, unplanned readmissions, reoperations and rates of conversion between pediatric and general surgeons (p>0.05).
Conclusion: There were no differences in outcomes when appendectomies were performed by either pediatric or general surgeons for adolescents with acute appendicitis. Adolescent patients can effectively undergo surgery at non-pediatric designated hospitals.
