Incidental Appendectomy Research Articles

Waugh's Syndrome: A Rare Presentation of Intussusception

A 3-month-old girl without underlying disease presented with non-bilious vomiting twice, and then suffered from currant jelly stool (Figure 1A) without irritable crying in 6 hours. Abdominal plain film showed gas dilated bowel loop and no gas in distal intestine (Figure 1B). Abdominal ultrasonography showed a target lesion (black arrow) over left upper quadrant of abdomen (Figure 2A). After laparotomy, ileo-cecal type intussusception with non-fixation of ascending colon was found (Figure 2B). Milking reduction of intussusception, incidental appendectomy and pexy for right side colon were performed. She recovered well after operation and discharged 4 days later. The rare association of intestinal malrotation in conjunction with intussusception was termed Waugh’s syndrome. It is important to be vigilant in children younger than three months with intussusception over atypical location, in these children have higher morbidity and mortality.

Evaluation of Diagnostic Laparoscopy with laparoscopic Appendectomy in Females with Acute Right Lower Quadrant Pain, a Multicenter Study

Background and aim of the study: Diagnostic laparoscopy is the gold standard for diagnosis of acute right lower abdominal pain (ARLQP) in females especially in child bearing age and its value to perform laparoscopic appendectomy in such complex conditions is gaining acceptance amongst surgeons. The aim of this multicenter study was to evaluate the values of diagnostic laparoscopy with laparoscopic appendectomy in female patients with acute right lower quadrant abdominal pain. Material and method: This multicenter prospective study enrolled 253 female patients who presented with acute right lower quadrant pain to Taif tertiary hospitals (Saudi Arabia) and performed laparoscopic appendectomy during diagnostic laparoscopy from May 2012 to April 2017. Results: The study included 253females with mean age of 31.1±6.8 years. Diagnostic laparoscopy with laparoscopic appendectomy was done for all of them. Acute appendicitis was the most common cause of ARLQP (22.1%). 10.5% of macroscopically normal appendices had acute appendicitis. Mean total operating time was 65.6±14.7 and for the appendectomy portion of the operation it was 14.3±2.8 minutes when the appendix was grossly inflamed and it was 11.8±2.3 minutes when the appendix was apparently normal (incidental appendectomy).The mean hospital stay for grossly inflamed appendix was 24.8±5.5 hours, of incidental appendectomy without associated pelvic pathology was 22.3±5.2 hours increased to 72.4±16.5 hours if other pelvic pathology was managed. Post operative complications occurred in 4%. No operative or early postoperative mortality was recorded. Conclusion: This study supports the value of diagnostic laparoscopy in diagnosis and management of females with ARLQP and verified that acute appendicitis is the most common cause in such females. The study proved also that laparoscopic appendectomy is safe, effective, quick in addition; the study verified the role of incidental appendectomy in prevention of reoperation for future appendicitis.

Neuroendocrine tumors of the appendix

Aim: The objective of this study was to evaluate treatment and postoperative recurrence in patients with neuroendocrine tumors of the appendix detected.Material and Methods: Patients with neuroendocrine tumors of the appendix detected between January 2015 and January 2016 were evaluated retrospectively. Patients who underwent incidental appendectomy due to different malignancies were excluded from the study. Results: A total of 402 patients who underwent appendectomy were evaluated. Five patients with neuroendocrine tumors detected, were included in the study. The mean age was 30.1 years. There were tumors in the apex, while a second tumor was found in the corpus in one patient. The mean tumor diameter was 0.6 cm. Ki-67 was under 2% in all patients. One patient underwent right hemicolectomy in the postoperative first month due to the infiltration to the periappendiceal tissue. The mean duration of hospitalization was 2 days. The mean duration of follow-up was 38 months (range 12- 54) . Ga 68 PET CT was taken in all patients after the histopathological examination. Control of the patients was performed after the first year with thorax and abdominal CT. None of the patients developed tumor. Conclusion: In general, clinical course is good and appendectomy is curative. However, right hemicolectomy is needed in patients with poor prognostic factors. Keywords: Incidental neuroendocrine tumor; appendectomy; general surgery.

Operative treatment for intussusception: Should an incidental appendectomy be performed?

Background/objectivesAn incidental appendectomy is performed by some surgeons during operative treatment for intussusception to eliminate future appendicitis as a diagnostic consideration. However, an appendectomy can increase the risk of infection and other noninfectious complications making an incidental appendectomy controversial. We examined outcomes for surgical intervention for intussusception with appendectomy (SWA) compared to surgical reduction alone (SRA). MethodsThe Pediatric Health Information System database, 8/2008–9/2015, was retrospectively analyzed for patients under the age of five who required an operative intervention for intussusception without bowel resection. Demographic data and postoperative outcomes were analyzed. Available data included need for postoperative enema, subsequent small bowel obstruction, recurrent intussusception, length of stay (LOS), and adjusted total cost (ATC). ResultsFifty-seven percent (748/1312) of patients had appendectomy performed during surgical reduction, 564 (43%) did not. ATC ($10,594 vs. $8939, p < 0.001) and LOS (3.0 vs. 2.48, p < 0.001) are higher in the SWA group. Rates of readmission are similar, but post-operative small bowel obstruction may be higher in the SWA group (1.3% vs. 0.35%, p = 0.06). ConclusionThere is a higher mean LOS and ATC in the SWA group. This study suggests that appendectomy during surgery for uncomplicated intussusception should be reconsidered and requires further investigation. Type of Studyretrospective comparative study. Level of EvidenceIII.

The Safety of Incidental Appendectomy at the Time of Total Laparoscopic Hysterectomy

The Safety of Incidental Appendectomy at the Time of Total Laparoscopic Hysterectomy

Laparoscopic Appendicectomy in All Benign Pathologies of the Appendix: A retrospective study

Background: Acute appendicitis is one of the most common surgical conditions and urgent appendicectomyis recommended and practiced for more than 100 years1,2. McBurney's appendicectomy by an open muscle splitting technique was the gold standard surgical procedure1. Laparoscopic appendicectomy (LA) is gaining popularity since 1987. But this new technique has a longer learning curve and requires expensive equipment (high capital investments).The aim of this study was to ascertain the generalizability of this novel procedure when appendicectomy is indicated.Method: This study was done over a period of six years in BIRDEM. Between March 2010 to February 2016, all consecutive cases of Laparoscopic appendicectomy was selected for the study. Operation was performed under general anaesthesia using standard three puncture technique. After the procedure all resected specimen was sent for histopathology.Result: Laparoscopicappendicectomy was attempted in 113 patients, 57(50.4%) female and 56(49.6%) males. Mean age of the patients were 35.2 years and ranged from 5 to 65 years. Laparoscopicappendicectomy was performed in emergency basis in 102(90%) due to acute appendicitis, gangrenous appendix, perforated appendix or appendicular abscess. Eleven patients (10%) underwent elective surgery due to interval appendicectomy, mucocole of appendix, incidental appendicectomy. The most common indication for laparoscopic appendicectomy in this series was acute appendicitis (62%). Only one patient (&lt;1%) had to be converted to an open appendicectomy due to injury to caecal wall. There was no peri-operative mortality in this series. Hundred and five patients (93%) weredischarged in lessthan 24 hours of surgery and seven (6%) within 48 hours of surgery after removal of intrabdominal drain. Follow-up period was one month to two years.Conclusion: All the advantages of laparoscopy are well applied in laparoscopic appendicectomy. Morbidity, mortality and conversion rate came down to a minimum with time and experience. Hence laparoscopic appendicectomy should be the procedure of choice when appendicectomy in indicated.Bangladesh Crit Care J September 2018; 6(2): 80-83

Appendectomy and risk of Parkinson's disease in two large prospective cohorts of men and women.

Prior work on appendectomy and PD has produced mixed results. In this study we examined whether history of self-reported appendectomy was related to risk of incident Parkinson's disease in the Nurses' Health Study and the Health Professionals Follow-up Study. We used the Cox proportional hazards model to estimate the hazard ratio of Parkinson's disease associated with self-report of appendectomy in men and women. Among women, we estimated the hazard ratio of Parkinson's disease associated with appendectomy for appendicitis and incidental appendectomy. In pooled analyses, self-report of any appendectomy was not related to Parkinson's disease risk: the hazard ratio of Parkinson's disease comparing participants who reported any appendectomy with those who did not was 1.08 (95% confidence interval, 0.94-1.23). In women, appendectomy for appendicitis, but not incidental appendectomy, was associated with a modestly elevated risk of Parkinson's disease (hazard ratio, 1.23 [95% confidence interval, 1.00-1.50]). Overall, this study suggests limited to no association between appendectomy and Parkinson's disease risk. © 2018 International Parkinson and Movement Disorder Society.

Primary ovarian signet ring cell carcinoma: A rare case report.

Signet ring cell carcinoma (SRCC) of the ovary is most commonly metastatic from a primary lesion. Primary ovarian SRCC is rare, and the distinction between primary and metastatic SRCC of the ovary may be difficult. We herein present a case of primary SRCC of the ovary in a 54-year-old woman presenting with a right ovarian mass sized 20.5×16.5×11.5 cm. Total abdominal hysterectomy with bilateral salpingo-oophorectomy, partial omentectomy and incidental appendectomy were performed. Upon histological examination, mucinous carcinoma composed predominantly of signet ring cells was observed in the right ovary. The results of immunohistochemical examination included diffuse positivity for cytokeratin (CK)7 and CK20, but the tumor was negative for estrogen receptor, progesterone receptor, caudal type homeobox 2 and Wilms' tumor gene 1. A preoperative computed tomography (CT) scan of the abdomen and a postoperative positron emission tomography-CT scan did not reveal any suspicious extraovarian lesions. Based on the histological and clinicoradiological examinations, this case was diagnosed as a primary ovarian SRCC.

Incidental appendectomy at the time of gynecologic surgery

Incidental appendectomy at the time of gynecologic surgery

Hospital type predicts computed tomography use for pediatric appendicitis

BackgroundEvidence-based guidelines recommend ultrasound (US) over computed tomography (CT) as the primary imaging modality for suspected pediatric appendicitis. Continued high rates of CT use may result in significant unnecessary radiation exposure in children. The purpose of this study was to evaluate variables associated with preoperative CT use in pediatric appendectomy patients. MethodsA retrospective cohort study of pediatric patients who underwent appendectomy for acute appendicitis in 2015–2016 at National Surgical Quality Improvement Program for Pediatrics (NSQIP-P) hospitals was conducted. Pediatric (<18 years old) patients who underwent appendectomy for acute appendicitis in an NSQIP-P hospital from 2015 to 2016 were included. Patients were excluded if they underwent interval or incidental appendectomy or did not have a final diagnosis of appendicitis. Variables associated with imaging evaluation, including age, body mass index (BMI), race/ethnicity, gender and hospital of presentation (NSQIP-P vs. non-NSQIP-P hospital) were evaluated. The primary outcome was receipt of preoperative CT. Secondary outcomes include reimaging practices and trends over time. Results22,333 children underwent appendectomies, of which almost all were imaged preoperatively (96.5%) and 36% of whom presented initially to a non-NSQIP-P hospital. Overall, US only was the most common imaging modality (52%), followed by CT only (27%), US+CT (16%), no imaging (3%), MRI +/− CT/US (1%) and MRI only (<1%). On regression, older age (>11 years), obesity (BMI >95th percentile for age), and female gender were associated with increased odds of receiving a CT scan. However, initial presentation to a non-NSQIP-P hospital was the strongest predictor of CT use (OR 9.4, 95% CI 8.1–10.8). Reimaging after transfer was common, especially after US and MRI at a non-NSQIP-P hospital. CT use decreased between 2015 and 2016 in non-NSQIP-P hospitals but remained the same (25%) in NSQIP-P facilities. ConclusionsThough patient characteristics were associated with different imaging practices, presentation at a referral, nonchildren's hospital is the strongest predictor of CT use in children with appendicitis. NSQIP-P hospitals frequently reimage transferred patients and have not reduced their CT use. Novel strategies are required for all hospital types in order to sustain reduction in CT use and mitigate unnecessary imaging. Level of EvidenceLevel III. Type of StudyRetrospective comparative study.

Small Bowel Lymphoma Coupled with Incidental Appendectomy in a Developing Community

Small Bowel Lymphoma Coupled with Incidental Appendectomy in a Developing Community

Pattern of presentation and outcome of management of acute appendicitis: A 10-year experience

Background: Appendicitis is one of the most common indications for nonelective abdominal surgery. This is true in both developed and developing countries. The aim of this study was to describe the pattern of presentation and outcome of management in a large hospital in the developing world. Methods: All patients of the general surgery divisions who had appendicectomy for clinical preoperative diagnosis of acute appendicitis between July 2007 and June 2016 were included in the study. Patients who had incidental appendicectomy were excluded from the study. Data were collected retrospectively using a data collection instrument designed for the study. Results: The total number of appendicectomy operations performed within the stipulated period was 1081. Male:female ratio was 1.37:1. The age range was from 12 years to 80 years. The most common symptom and sign remain the right lower quadrant pain and right iliac fossa tenderness, respectively. The duration of symptoms before presentation ranged from 10 h to 96 h. Approximately 20% or a fifth of the patients had ruptured appendix. Tumor associated appendicitis constituted 2.2%. The negative appendicectomy rate was 9.5%. About 47% of the patients were discharged

Occult Appendiceal Neoplasms in Acute and Chronic Appendicitis: A Single-Institution Experience of 1793 Appendectomies

The incidence of appendiceal neoplasms may have been underreported in the past. Patients undergoing incidental appendectomies or appendectomies for chronic appendicitis may be at higher risk for an incidental appendiceal neoplasm. To determine the incidence of occult appendiceal neoplasms and identify risk factors associated with this pathology, a retrospective review of a pathology specimen database was conducted from November 2007 to December 2011, in a single tertiary care hospital center. All patients with appendectomies were included for analysis (n = 1793). Pathology specimens were grouped based on the indication for appendectomy, and the incidence of appendiceal neoplasms, and patient variables among the groups were compared using χ2 test and Student's t test. A total of 1793 appendectomy specimens met criteria for evaluation. The total number of appendiceal neoplasms was 31 (1.7%). There were 14 neoplasms in 1337 (1.0%) cases of acute appendicitis with 2 in 41 (4.9%) cases of chronic and 15 in 415 (3.6%) cases, where an incidental appendectomy was performed (P < 0.001). Patients with carcinoid tumors were significantly younger than patients with noncarcinoid tumors (P = 0.0001). Indication for operation was the only significant factor for predicting an appendiceal tumor on final pathology. Patients who undergo interval or incidental appendectomies may be at higher risk of appendiceal neoplasm compared with those performed for other indications. Younger patients may be at a higher risk of occult appendiceal carcinoid neoplasms than other age groups. Pathologic diagnosis in specific high-risk patient groups may be the only way to effectively capture these tumors for optimal treatment.

Incidental appendectomy during robotic laparoscopic prostatectomy-safe and worth to perform?

The purpose of this study is to investigate the safety and patients' benefit of incidental appendectomy during robot-assisted laparoscopic radical prostatectomy (RALRP). Fifty-three patients, who had incidental appendectomy during RALRP between January 2012 and March 2014, were enrolled to this study. To evaluate the safety of the procedure, following parameters were evaluated: patient age, duration of surgery, perioperative complications (classified by Clavien-Dindo), time to bowel movement, and length of hospital stay. Furthermore, intraoperative visual appearance, location, and histopathological evaluation of the appendix were evaluated. Data was analyzed by descriptive statistics. Mean age of patients was 61years, the average hospital stay 5days. No perioperative complications occurred. The appendix was unsuspicious in 39 patients (73.6%); 14 patients (26.4%) had macroscopically signs of inflammation. Of the 53 resected appendixes, the histopathological evaluation showed 33 (62.2%) inconspicuous appendices, 11 (20.8%) post-inflammatory changes, 4 (7.5%) with chronical signs of inflammation and 3 (5.7%) with signs of acute inflammation. In 2 patients (3.8%), low-grade mucinous neoplasms were found in the specimens. Incidental appendectomy during RALRP is a feasible procedure. With regard to inflammation and neoplastic changes, incidental appendectomy can be considered for patients scheduled for robot-assisted prostate surgery.

TEKNIK RELAKSASI GENGGAM JARI TERHADAP INTENSITAS NYERI PADA PASIEN POST APPENDIKTOMI

P a in is a condition more than a single sensation caused by a certain stimulus. One of the non-pharmacological erections in handling pain is a hand-held relaxation technique. Finger hand-held real-time techniques can reduce physical and emotional strain that will relax the body. This study aims to examine the effect of finger hand relaxation technique on the intensity of pain in post appendectomy patients. This research uses Quasy Experiment design with One Group Pre-test Post- Stestdesign. The total population of this study were all patients of post appendectomy in Achmad Mochtar Hospital. Sampling technique using purposive sampling technique. This study was conducted on February 17 until 1 May 2017 in the hospital surgery room Achmad Mochtar Bukittinggi. Data were analyzed by using Paired T-Test with significant value α = 0,005. The results showed that the average before hand-held finger relaxation technique was 4.80 and the mean result after hand-held relaxation technique was 3.87. Bivariate results obtained p value 0,000. So it shows there are differences in pain intensity before and after hand-held relaxation techniques in patients post appendectomy. From the results of the above research can be concluded that the implementation of handheld relaxation techniques affect the reduction of post incision appendectomy incision.

Primary segmental omental infarction as a rare cause of acute abdominal pain in childhood

Abstract Introduction Primary omental infarction (POI) has a low incidence worldwide, with most cases occurring in adults. This condition is rarely considered in the differential diagnosis of acute abdominal pain in childhood. Material and methods We present 2 cases of omental infarction in an obese 8-year-old boy and a 5-year-old boy who presented with acute abdominal pain in the right abdomen. Both patients were initially treated with intravenous fluids and analgesics with no improvement. Abdominal ultrasound of the first patient showed free intraperitoneal fluid, meteorism and distended bowel loops. The appendix was not visualized. With a presumptive clinical diagnosis of appendicitis the child underwent laparotomy. On entering the peritoneal cavity an omental infarction was seen and a portion of the omentum was resected. Appendectomy was performed. The second patient presented with acute abdominal pain in the right upper quadrant, which started 2 days before. There was a history of possible abdominal trauma about 3 weeks earlier. The patient had repeated ultrasound examinations and a CT scan of the abdomen which showed a omental infarction. He underwent laparoscopy and resection of the omental infarction, as well as incidental appendectomy. Results The postoperative period was uneventful. The first patient was discharged on day 3, the second patient on day 4 after surgery. Histology showed a normal vermiform appendix and an omental infarction in both cases. Conclusion and discussion Since the omental infarction as etiology of acute abdominal pain is uncommon in children, we emphasize the importance of accurate diagnosis and appropriate treatment of omental infarction.

Incidental appendectomy during mini incision post-partum sterilization (Chokchai technique): A prospective cross-sectional study.

We aimed to determine the success rate of incidental appendectomy during post-partum sterilization (PPS) using the Chokchai technique and to compare the postoperative morbidity between patients who underwent this procedure with those who underwent simple PPS. Appendectomy during PPS was performed in 141 patients from 1 May 2012 to 30 April 2014. The control group consisted of 182 simple PPS patients. Primary outcomes were the success rate of the procedure and secondary outcomes were postoperative morbidity and complications. The success rate of this procedure was 98.6%. There was no statistically significant difference in intraoperative blood loss, hospital length of stay, or postoperative morbidity. Appendectomy added 7.5 min to the total procedure. Intravenous sedation requirements were 13.7% and 33.3% in the control and study groups, respectively. Pathologic evaluation of resected appendices revealed 15 abnormalities (10.8%), including two cases of periappendicitis (1.4%). When carried out by experienced surgeons and with appropriate anesthesia, incidental appendectomy during PPS is safe. The Chokchai technique (approach through a small periumbilical incision) achieved a high success rate and resulted in minimal scar. Incidental appendectomy not only prevents any future appendicitis but also helps to detect periappendicitis and treat its primary cause. However, this is an option for only selected patients who are clearly informed about the possible risks and benefits of the procedure.

Appendectomy at Gynecologic Surgery: Feasibility and Outcomes in a High Risk Gynecologic Population—Revealing a High Rate of Incidental Appendiceal Cancer

Objective: Appendectomy during gynecologic surgery is not performed routinely by most providers, even in patients with pelvic pain complaints or with gynecologic malignancies. Appendectomy, concordant with cancer debulking, can optimize surgical outcomes, and, in patients with pelvic pain, can help diagnose pathologic etiology for those symptoms. With a lifetime rate of appendicitis of 7%–9%, incidental appendectomy can reduce risk for future complications of appendicitis. Design: A retrospective chart review of all patients operated on from April 2012 to July 2016 was performed. Materials and Methods: Data were abstracted to include: age; body mass index; route and indication for surgery; final pathology; complications; and feasibility. Statistics were calculated, using Excel 2007 and the R Project. Results: Charts for 920 patients were reviewed. Of these, charts for 69 patients were excluded due to extraperitoneal procedures; 110 patients had prior appendectomies. There were no complications. In the remaining charts, there were 14 incidental appendiceal primary cancers, 54 metastatic gynecologic cancers wherein appendectomy contributed to optimal debulking, 15 cases of acute appendicitis, and 8 appendiceal specimens with endometriotic implants. Conclusions: Incidental appendectomy is a safe and feasible procedure for both laparoscopic and open abdominal–pelvic procedures. There was a high rate of incidental primary appendiceal cancers, at 2.97%. There was also a high rate of other pathologies, including metastatic tumors, endometriosis, and appendicitis. Removing the appendix during gynecologic surgery can reduce the risks for present and future gastrointestinal cancer, and appendicitis with rupture, as well as contributing to high-quality surgical care in patients with cancer and pelvic pain. (J GYNECOL SURG 33:145)

A review of appendectomy cases at a single teaching hospital, Baghdad, Iraq

Background: Appendectomy is one of the most commonly performed operations. Accurate preoperative diagnosis has long been a great challenge, even to experienced surgeons. To determine the pattern of presentation and rate of atypical pathological presentation of appendicitis.Methods: This is a cross-sectional study in which patients who underwent appendectomy for presumed acute appendicitis from June 2012 to June 2016 were recruited. Incidental appendectomy was excluded. Patient demographics, pathological findings, and surgical outcomes were collected.Results: It was found that the median age of the patients with acute appendicitis was 29 (male 27.3, female 30.7; range (4-67) years. The median length of hospital stay was 2 (range, 1-22) days. There were 184 (75%) patients with clinically and pathologically confirmed acute appendicitis. Out of the 243 patients, 47 appendices were normal, making the overall negative appendectomy rate (NAR) 19.3%; 14.0% in males and 24.6% in females (P&lt;0.001).Conclusions: Appendectomy continues to be a very common surgical procedure. We suggest a more liberal utilisation of preoperative imaging in females of reproductive age, and patients at the extreme age.

Safety of perioperative ketorolac administration in pediatric appendectomy

BackgroundRecent studies in adults undergoing gastrointestinal surgeries show an increased rate of complications with the use of ketorolac. This calls into question the safety of ketorolac in certain procedures. We sought to evaluate the impact of perioperative ketorolac administration on outcomes in pediatric appendectomy. MethodsThe Pediatric Health Information System database was queried for patients aged 5-17 y with a primary diagnosis of appendicitis and a primary procedure of appendectomy during the period 2010-2014. Patients with procedures suggesting incidental appendectomy, those records with data quality issues, deaths, and extracorporeal membrane oxygenation were excluded. Variables recorded included age, sex, race, ethnicity, discharge year, complex chronic conditions, geographic region, intensive care unit admission, mechanical ventilation, and whether appendicitis was coded as complicated. The exposure variable was ketorolac administration on the day of or day after operation. The primary outcomes of interest were any surgical complications during the initial encounter, postoperative length of stay (LOS), total cost for the initial visit, any readmission to ambulatory, observation, or inpatient status within 30 d, and readmission with a diagnosis of peritoneal abscess or other postoperative infection or with transabdominal drainage performed. ResultsA total of 78,926 patients were included in the analysis cohort. Mean age was 11.4 y (standard deviation 3.3 y), the majority were males (61%), White (70%), and non-Hispanic (65%). Few had a complex chronic condition (3%) or required mechanical ventilation (2%) or an intensive care unit admission (1%). Patients with complicated appendicitis comprised 28% of the cohort. Most (73%) received ketorolac on postoperative day 0-1; those with complicated appendicitis were more likely to receive ketorolac. In all, 2.6% of the cohort had a surgical complication during the index visit, 4.3% were readmitted within 30 d, and 2% had a postoperative infection or transabdominal drainage (1% in the uncomplicated group and 5% in the complicated group). Median postoperative LOS was 1 d and mean cost was $9811 ± $9509. On bivariate analysis, ketorolac administration was associated with a decrease in same-visit surgical complications (P = 0.004) and cost ($459 decrease, P < 0.001) but was not associated with readmission, postoperative LOS, or postoperative infection. On multivariate analysis, ketorolac administration was associated with a significant decrease in any complication (adjusted odds ratio 0.89, 95% confidence interval 0.80-0.99) and cost (analysis of variance P < 0.001) but was not associated with readmission, postoperative LOS, or postoperative infection. ConclusionsBased on a large, contemporary data set from children's hospitals, ketorolac administration in the immediate postoperative period after appendectomy for appendicitis is common and was not associated with an increase in postoperative LOS, postoperative infection, or any-cause 30-d readmission. Ketorolac was, however, independently associated with a lower overall rate of postoperative complications and cost in this population.