Delayed Surgery for Perforated Appendicitis is Feasible in Children Without Compromising the Outcome in Selected Cases

Abstract

The relationship between time to surgery and risk of postoperative complications and re-intervention has not been conclusively investigated in pediatric perforated appendicitis (PA). The aim of this study was to determine whether time to appendectomy (TTA) is a risk factor for postoperative complications and re-intervention in a cohort of children undergoing appendectomy for PA. A total of 254 children (age: 8.7 ± 3.7years) undergoing appendectomy for PAwere retrospectively evaluated and stratified into Group I-III according to the Clavien-Dindo classification for postoperative complications (Group I n = 218, 86%; Group II n = 7, 3%; Group III n = 29, 11%). The TTA was comparable between all groups (group I: 8.8 ± 9.2h; group II: 7.8 ± 5.3h; group III: 9.5 ± 9.6h; overall: 8.8 ± 9.1h; p = 0.885). A C-reactive protein (CRP) value at admission of ≥128.6mg/l indicated a higher risk for developing Grade II complications with no need for re-intervention (OR: 3.963; 95% CI: 1.810-8.678; p = 0.001) and Grade III complications with the need for re-intervention (OR: 3.346; 95% CI: 1.456-7.690; p = 0.004). This risk was independent of the TTA (OR: 1.007; 95% CI: 0.980-1.035; p = 0.613). Appendectomy can be delayed by an average time delay of about9h in children with PA without increasing the risk of postoperative complications and re-intervention, also in patients at high risk defined by the initial CRP level ≥ 128.6mg/l. This data may support the correct risk-adjusted scheduling of surgical interventions in times of limited capacity.