B. Pham1, B. Range3, D. S. Plurad1, S. Lee3, A. Kaji2, S. Bricker1, B. Putnam1, D. Y. Kim1 1Harbor-UCLA Medical Center,Division Of Trauma/Acute Care Surgery/Surgical Critical Care,Torrance, CA, USA 2Harbor-UCLA Medical Center,Department Of Emergency Medicine,Torrance, CA, USA 3Harbor-UCLA Medical Center,Department Of Surgery,Torrance, CA, USA
Introduction: Acute care surgery (ACS) is an evolving specialty and studies examining the role of the acute care surgeon in managing pediatric surgical emergencies are limited. The purpose of this study was to compare outcomes following pediatric appendectomy between an ACS service and pediatric surgery (PS) service. We hypothesized that there is no difference in the rate of complications when pediatric appendectomy is performed by an acute care surgeon versus a pediatric surgeon.
Methods: A 5-year retrospective analysis of all appendectomies performed in patients ≤12 years old at a university-affiliated County hospital was performed. The primary outcome was 30-day postoperative complications including superficial and deep surgical site infections, sepsis, readmission, and reoperation. Secondary outcomes included time to the operating room (OR), duration of surgery, and length of stay (LOS). Multivariate logistic regression analysis was performed to identify independent predictors of complications.
Results: Of 503 patients, 320 (64%) were treated by the ACS service and 183 (36%) by the PS service. Patients managed by the ACS service were older (9 vs. 7 years old, p<0.0001), underwent preoperative ultrasonography more commonly (47% vs. 13%, p<0.0001), and were more likely to undergo a laparoscopic appendectomy (40% vs. 15%, p<0.0001). Time to the OR and duration of surgery were shorter among patients managed by the PS service (p<0.01), whereas LOS was increased (OR=3.0; 95%CI=2.0-5.0, p<0.0001). There was no significant difference in the incidence of complications between the ACS and PS services (12% vs. 18%, p=0.06). On multivariate analysis, after adjusting for surgical service and approach, age, gender, body mass index, and appendicitis severity, the intraoperative finding of perforated appendicitis was the only variable associated with postoperative complications (OR=3.6; 95%CI=1.9-6.8, p=0.0001).
Conclusion: Acute care surgeons are capable of managing pediatric appendicitis with outcomes similar to their pediatric surgery colleagues. Patient age alone should not exclude involvement of an ACS service in the management of patients with acute appendicitis.