Outcomes Of Appendectomy Research Articles

Appendectomy for Appendicitis Has Worse Hospital Outcomes in Inflammatory Bowel Disease (IBD): 2016 ACG Presidential Poster Award

Introduction: Appendectomy for acute appendicitis is the most common emergent abdominal surgery but less is known about hospital outcomes within the IBD population. Our study compared hospital outcomes of appendectomy between those with Crohn's disease (CD) and ulcerative colitis (UC) and those without IBD. Methods: This was a cross-sectional study using data from the Nationwide Inpatient Sample (NIS, 2009-2013). Patients with either UC or CD undergoing an appendectomy for appendicitis were identified using ICD-9-CM codes. The following patients were excluded: (a) Age < 18 years; (b) Patients listed with both diagnoses of UC and CD; (c) Surgery performed electively. Patients with CD and UC were compared to patients without IBD through multivariate analyses in terms of Patient Safety Indicators (PSI), postsurgical complications, length of stay (LOS) and cost. Results: Among the total of 849,312 patients, there were 2416 CD patients (0.003%) and 1845 UC patients (0.2%). Compared to non-IBD patients, CD patients were more likely to develop post-surgical complications, have prolonged LOS, and increased hospital costs (Table 1). Significant post-surgical complications included pulmonary embolism (PE) and post-operative anemia. UC patients were more likely to have prolonged LOS, incur higher hospital costs and more PSI's (Table 1). Although post-surgical complications overall were not statistically significantly different between the UC patients and non-IBD patients, individual analysis of post-surgical complications demonstrated that UC patients were more likely to develop deep venous thromboses (DVT). Finally, analysis of appendicitis type showed that CD patients were more likely to have perforated appendices and undergo open appendectomy, while UC were more likely to have non-perforated appendices (Table 2).Table 1: Patient with CD undergoing appendectomy for appendicitis were more likely to have post-surgical complications, increased legnths of stay and incur higher hospital costs compared to those without IBD. Patients with UC were more likely to have increased lengths of stay, increased hospital costs and more PSI's compared to patients without IBD.Table 2: Patients with CD were more likely to have perforated appendices and required open appendectomy. Patients with UC were more likely to have non-perforated appendices and laparoscopic appendix removal.Conclusion: Our study is the first to show that patients that with IBD undergoing appendectomy for appendicitis had prolonged LOS and incurred higher hospital costs. CD patients undergoing appendectomy are likely to have PE and post-operative anemia, while UC patients are more prone to PSI and DVT. CD patients are most likely to undergo an open appendectomy and have a perforated appendix. This can likely be attributed to the transmural disease process of CD. This study can help guide surgical risk discussions with the IBD patients, particularly PE and DVT. Therefore, DVT prophylaxis is more important in IBD patients undergoing appendectomy for appendicitis.

Effects of diagnosis-related group payment system on appendectomy outcomes

BackgroundThe voluntary diagnosis-related group (DRG) payment system was introduced in 2002. Since July 2013, the Korean government has mandated DRG participation for all hospitals. The main purpose of this study was to examine the effects of mandatory DRG participation on various outcome metrics for appendectomy patients. Materials and methodsWe collected inpatient DRG data for 280,062 appendectomy patients between 2007 and 2014 using the Health Insurance Review and Assessment database. We examined patient outcome metrics such as length of stay (LOS), total medical cost, spillover, and readmission rate, according to hospital size. ResultsAs a result of DRG participation, the average LOS for patients decreased (adjusted ratio: 0.83 [large hospitals], 0.83 [small hospitals]; 95% confidence interval [CI]: 0.82-0.84, 0.82-0.84), the total medical costs of patients increased (adjusted ratio: 1.23 [large hospitals], 1.35 [small hospitals]; 95% CI: 1.22-1.24, 1.34-1.36), the spillover of patients increased (adjusted ratio: 2.10 [large hospitals], 2.30 [small hospitals]; 95% CI: 2.03-2.18, 2.16-2.45), and the readmission rates of appendectomy patients decreased (adjusted ratio: 0.85 [large hospitals], 0.49 [small hospitals]; 95% CI: 0.77-0.94, 0.42-0.57). ConclusionsThe mandatory implementation of the DRG payment system in South Korea has led to significant reductions in LOS and readmission rates for appendectomy patients. However, any resulting expansion of outpatient services may result in unnecessary resource usage rather than improving medical quality. Policy makers should consider the various implications reflected by these results when considering DRGs for other diseases.

Predictive factors and outcomes of negative appendectomy

BackgroundThe aim of this study was to assess predictive factors for negative appendectomy and to evaluate the outcomes of negative appendectomy. MethodsA retrospective chart review of 4,878 patients who underwent appendectomy at our institution from January 2008 to December 2014 was performed. ResultsYounger age (≤15 years), normal white blood cell count, appendix diameter of less than 6 mm on computed tomography (CT), and CT grade less than 3 were found to be independent predictive factors for negative appendectomy. When complications were investigated according to the results of pathologic diagnosis, negative appendectomy had more complications than appendectomy for nonperforated appendicitis, and this was statistically significant. ConclusionsWhen CT findings are equivocal, in deciding to operate for acute appendicitis, additional ultrasonography can be performed. Furthermore, if the patient is younger than 15 years and the white blood cell count is normal, it is recommended to monitor changes in symptoms a little longer rather than operating hastily.

Hospital preference of laparoscopic versus open appendectomy: Effects on outcomes in simple and complicated appendicitis

PurposeWe hypothesize that laparoscopic (LA) or open appendectomy (OA) outcomes are associated with hospital procedure preference. MethodsWe queried Kids' Inpatient Database (1997–2009) for simple (ICD-9-CM 540.9) and complicated (540.0, 540.1) appendicitis. ResultsOn PS-matched analysis of simple appendicitis (91,118 LA vs. 97,496 OA), LA had increased transfusion (1.7) rates, but lower wound infection (0.6) and perforation/laceration (0.3) rates. LA had shorter length of stay (LOS; 1.7 vs. 2.1days), but higher total charges (TC; 19,501 vs. 13,089 USD) and cost (7121 vs. 5968) vs. OA. For complicated appendicitis (28,793 LA vs. 30,782 OA), LA had increased nausea/vomiting rates (1.9), but lower wound infection (0.5) and transfusion (0.6) rates. LA had shorter LOS (5.1 vs. 5.9), but higher TC (32,251 vs. 28,209).MVA demonstrated shorter LOS (0.9) for LA at laparoscopic-preferring hospitals vs. open-preferring hospitals for simple appendicitis. For complicated appendicitis, higher complication rates (1.1) were associated with OA at laparoscopic-preferring hospitals. Laparoscopic-preferring hospitals had higher TC in all categories. ConclusionComplications and resource utilization for appendicitis are associated with surgical technique and hospital procedure preference. Laparoscopic-preferring hospitals had higher complication rates with OA for complicated appendicitis and higher charges regardless of appendectomy technique or appendicitis type.Level of Evidence: 2c, Outcomes Research.

Are appendectomy outcomes in level I trauma centers as good as we think?

BackgroundDesignated trauma centers improve outcomes for severely injured patients. However, major trauma workload can disrupt other care pathways and some patient groups may compete ineffectively for resources with higher priority trauma cases. This study tested the hypothesis that treatment at a higher-level trauma center is an independent predictor for worse outcome after appendectomy. MethodsAn observational study was undertaken using an all-payer longitudinal data set (California State Inpatient Database 2007–2011). All patients with an ICD-90-CM diagnosis of “acute appendicitis” (International Classification of Diseases, Ninth Revision, Clinical Modification code 540) that subsequently underwent appendectomy were included. Patients transferred between hospitals were excluded to minimize selection bias. The outcome measures were days to the operating room, length of stay, unplanned 30-d readmission (to any hospital in California), and in-hospital mortality. Logistic and generalized linear regression models were used to adjust for patient- (age, sex, payer status, race, Charlson comorbidity index, weekend admission, and generalized peritonitis) and hospital-level (teaching status and bed size) factors. ResultsThere were 119,601 patients treated in 278 individual hospitals. Patients in level I trauma centers (L1TCs) reached the operating room later (predicted mean difference 0.25 d [95% confidence interval 0.14–0.36]), stayed in hospital longer (0.83 d [0.36–1.31]), and had higher adjusted odds of generalized peritonitis (odds ratio 1.63 [95% confidence interval 1.13–2.36]) than those in nontrauma centers. There were no differences in mortality or unplanned 30-d readmissions to hospital; or between level II trauma centers and nontrauma centers across any of the measured outcomes. ConclusionsOdds of generalized peritonitis are higher and hospital length of stay is longer in L1TCs, although we found no evidence that patients come to serious harm in such institutions. Further work is necessary to determine whether pressure for resources in L1TCs can explain these findings.

The influence of obesity on laparoscopic appendectomy as an option choice in children

Introduction: Acute appendicitis is the most common indication for abdominal surgery in children. Despite the increase of obesity in children, little data exist that examine the impact of obesity on surgical outcomes in children. Laparoscopic appendectomy has become more popular and it is used more often in treating obese children. Aim: The aim of this study is to evaluate the impact of obesity on operative and postoperative recovery of children with acute appendicitis, treated with open and laparoscopic method, and to determine which of these techniques is superior. Material and methods: We analyzed medical reports of children treated for acute appendicitis. This study included 330 patients. We used age percentile tables for weight and defined child obesity as weight at or above 90th percentile. Both obese and non-obese patients were divided into two groups: patients who underwent open surgery (OA), and those who underwent laparoscopic surgery (LA). We analyzed gender and age of our patients, their operative time, hospital stay, leukocytes count and complication rate. Results: The study includes 330 patients treated for acute appendicitis. There were 69 obese children (21%). The open technique was more often used in treating both obese (84%) and non-obese patients (76%). Obesity has been shown to increase operative time and hospital stay with no statistical significance, but with significantly higher incidence of complications after OA (67%) than after LA (33%). In the group of non-obese children, there was also significantly higher incidence of complications after OA (91%) than after LA (9%). Conclusion: According to observed parameters, obesity in our patients has no significant impact on the outcome of appendectomy in children. Concerning that there is no significantly high incidence of total number of complications referring to OA, laparoscopic technique should be recommended in treating all stages of acute appendicitis, both in obese and non-obese children.

Outcome after introduction of laparoscopic appendectomy in children: A cohort study

IntroductionAcute appendicitis in children is common and the optimal treatment modality is still debated, even if recent data suggest that laparoscopic surgery may result in shorter postoperative length of stay without an increased number of complications. The aim of the study was to compare the outcome of open and laparoscopic appendectomies during a transition period. Materials and methodsThis was a retrospective cohort study with prospectively collected data. All patients who underwent an operation for suspected appendicitis at the Astrid Lindgren Children’s Hospital in Stockholm between 2006 and 2010 were included in the study. Results1745 children were included in this study, of whom 1010 had a laparoscopic intervention. There were no significant differences in the rate of postoperative abscesses, wound infections, readmissions or reoperations between the two groups. The median operating time was longer for laparoscopic appendectomy than for open appendectomy, 51 vs. 37minutes (p<0.05). The postoperative length of stay was similar in the two groups. A simple comparison between the groups suggested that laparoscopic appendectomy had a shorter median postoperative length of stay, 43 vs. 57hours (p<0.05). However, there was a trend in time for a shorter postoperative length of stay, and a trend for more of the procedures to be performed laparoscopically over time so on regression analysis, the apparent decrease in length of stay with laparoscopy could be ascribed to the general trend toward decreased length of stay over time, with no specific additional effect of laparoscopy. ConclusionsOur data show no difference in outcome between open and laparoscopic surgery for acute appendicitis in children in regard of complications. The initial assumption that the patients treated with laparoscopic surgery had a shorter postoperative stay was not confirmed with linear regression, which showed that the assumed difference was due only to a trend toward shorter postoperative length of stay over time, regardless of the surgical intervention.

A Comparative Study between the Outcome of Laparoscopic Appendectomy and Open Appendectomy in Children

Background: Laparoscopic surgery for acute appendicitis in children has been proposed to have advantages over conventional surgery.Introduction: Appendicitis is the most common surgical emergency in childhood. 1 For decades, Open appendectomy (OA) has been the standard treatment for all forms of appendicitis with excellent results.2 Since its description in the early 1980s, laparoscopic appendectomy (LA) became an acceptable approach for simple appendicitis in children.3, 4, 5However, its role in the treatment of complicated appendicitis is controversial. Today, in developed countries about 8% of the population is appendectomized for acute appendicitis during their lifetime.7Materials and method: We are conducting a prospective comparative study with the intention to observe the outcome of 60 purposively selected patients of acute appendicitis in the Department of Pediatric Surgery, Dhaka Medical College &amp; Hospital (DMCH), Dhaka, over a period of 12 months from October, 2013 to October, 2014. The patients are going to be divided into 2 groups by random sampling- Group A- OA Group (patients underwent open appendectomy) and Group B- LA Group (patients underwent laparoscopic appendectomy) for uncomplicated appendicitis. Children up to 14 years are planned to be selected as study subjects. All children are subjected to investigate for white blood cell (WBC) count, plain X- ray KUB region, urine R/E, preoperatively and to observe the amount of analgesics in postoperative pain management and cosmesis on first week, first month, and third month of operation. Structured questionnaire is used to collect information regarding pain, fever, other association preoperatively and operative procedure, duration of operation, per operative findings and post operative follow up. Informed written consent from parents or legal guardian is taken after describing the study objectives. Ethical clearance has been sought from the Ethical Committee of Dhaka Medical College.Results: Total 23 patients are studied till now, 16 in LA group and 7 in OA group. From this limited data we have seen that there is apparently minimum difference between two groups of study population regarding postoperative outcomes.Conclusion: This is an on-going study. Definite conclusion could not be drawn at this preliminary stage. Laparoscopic appendectomy for uncomplicated appendicitis in children is feasible and safe. It is associated with a significantly less use of post operative pain killer, lower incidence of wound infection, and reduced length of hospital stay when compared with patients who had open appendectomy.J. Paediatr. Surg. Bangladesh 5(1): 25-29, 2014 (January)

The Timing of Antibiotic Therapy Must Be Controlled for When Assessing Appendectomy Outcomes

The Timing of Antibiotic Therapy Must Be Controlled for When Assessing Appendectomy Outcomes

Effect of Hospital Volume on Outcomes of Laparoscopic Appendectomy for Acute Appendicitis: an Observational Study

BackgroundThis study investigated the effect of hospital volume on outcomes of laparoscopic appendectomy for acute appendicitis. MethodsIn total, 30,525 patients who underwent laparoscopic appendectomy for acute appendicitis were referred to 825 hospitals in Japan from 2010 to 2012. We compared appendectomy-related complications, length of stay (LOS), and medical costs in relation to hospital volume. For this study period, hospitals were categorized as low-volume hospitals (LVHs, <50 cases), medium-volume hospitals (MVHs, 50–100 cases), or high-volume hospitals (HVHs, >100 cases). ResultsSignificant differences in appendectomy-related complications were observed among the LVHs, MVHs, and HVHs (6.9, 7.2, and 6.0 %, respectively; p = 0.001). Multiple logistic regression revealed that HVHs were associated with a lower relative risk of appendectomy-related complications than were LVHs and MVHs (odds ratio [OR], 0.84; 95 % confidence interval [CI], 0.74–0.95; p = 0.006). Multiple linear regression showed that HVHs were associated with shorter LOS and lower medical costs than were LVHs and MVHs. The unstandardized coefficient for LOS was −0.92 days (95 % CI, −1.07 to −0.78; p < 0.001), whereas that for medical costs was − $167.4 (95 % CI, −256.2 to −78.6; p < 0.001). ConclusionsHospital volume was significantly associated with laparoscopic appendectomy outcomes.

Prospective observational study of practice and outcome of emergency appendectomies in a single centre

Prospective observational study of practice and outcome of emergency appendectomies in a single centre

Impact of a 24-hour discharge pathway on outcomes of pediatric appendectomy

Clinical pathways for simple (nonperforated, nongangrenous) appendicitis potentially could decrease hospital length of stay (LOS) through standardization of patient care. Our institution initiated a simple appendicitis pathway for children with the goal of less than 24-hour discharge (same-day discharge, SDD) and evaluated its effectiveness. A prospective cohort of pediatric patients (<18 years of age) who underwent appendectomy for simple appendicitis after implementation of a SDD pathway were compared with a historic cohort of similar patients in this same large children's hospital. Primary outcomes included LOS, surgical-site infections, and readmissions. Mann Whitney U test, Fischer exact test, χ(2) test, and logistic regression were used. Between June 2009 and May 2013, 1,382 appendectomies were performed; 794 (57%) were for simple appendicitis (316 prepathway and 478 pathway). Hospital LOS decreased 37% after pathway implementation from a median (interquartile range) of 35 (20-50) hours to 22 (9-55) hours (P < .001). SDD increased from 13% to 58% (P < .001). Infectious complications were unchanged (1.6% vs 1.8%, P = .82), but readmissions increased (1.2% vs 4.2%, P = .02). A standardized pathway for simple appendicitis that targets SDD can be achieved in children; however, a slight increase in readmissions was noted. High risk for readmission, cost effectiveness, and generalizability need to be further determined.

Could Preoperative Ultrasound Examination Improve the Final Outcome of Appendectomies ?

Could Preoperative Ultrasound Examination Improve the Final Outcome of Appendectomies ?

Shifts towards pediatric specialists in the treatment of appendicitis and pyloric stenosis: Trends and outcomes

BackgroundLittle data exists on temporal changes in the care of children with common surgical conditions. We hypothesized that an increasing proportion of procedures are performed at pediatric hospitals over time, and that outcomes are superior at these centers. MethodsWe conducted a retrospective cohort study using Washington State discharge records for children 0–17years old undergoing appendectomy (n=39,472) or pyloromyotomy (n=3,500). Pediatric hospitals were defined as centers with full-time pediatric surgeons. Outcomes were examined for two time periods (1987–2000, 2001–2009). ResultsFrom 1987 to 2009, the proportion of procedures performed at pediatric hospitals steadily increased. The percentage for appendectomies increased from 17% to 32%, and that for pyloromyotomies increased from 57% to 99%. For pyloromyotomy, care at a pediatric hospital was associated with decreased risk of postoperative complications (OR=0.36, p<0.001) for both time periods. Appendectomy outcomes did not differ significantly in the early time period, but in the later time period specialist care was associated with lower risk of complications in children <5years (OR=0.54, p=0.03). ConclusionThere has been a shift towards pediatric hospitals for certain procedures, with a widening disparity in outcomes for younger children. These results suggest that procedures in younger patients may best be performed by providers familiar with these patient populations.

Pediatric appendectomy: An example of a tailored approach to resident supervision

Mizrahi et al [1] reported the results of a retrospective review comparing outcomes of pediatric appendectomy when performed by pediatric surgical attendings or by general surgery residents alone. Their findings of similar patient outcomes, irrespective of the presence of a pediatric surgeon, raise provocative issues and questions about the current practices within general surgery training programs.

Outcomes of Operative Management of Appendicitis

There has not been an appraisal of outcomes of appendectomy for more than 10 years. More reliable diagnostic techniques and minimally invasive surgery are now in widespread use, yet the impact of these advances remains unknown. A retrospective review was performed of 453 patients who underwent appendectomy for appendicitis at a single hospital from 2004 to 2009. Patient demographics, operative characteristics, procedure cost, and pathologic diagnoses were analyzed. The overall rate of complicated appendicitis was 13%, with a negative appendectomy rate of 4.9%. The average age was significantly greater for patients with complicated versus uncomplicated appendicitis (47 vs. 33 years, respectively; p<0.001), and by logistic regression, age (as a continuous variable) was a significant factor for complicated appendicitis (p<0.001). The hospital length of stay was 2.3 times longer for patients with complicated appendicitis (4.4 vs. 1.9 days; p<0.001), and the average cost was 86% higher ($14,125 vs. $7,595; p<0.001), the difference in cost being attributable mostly to pharmacy and nursing costs. Advances in diagnostic and surgical technique may be altering traditionally accepted rates of complicated appendicitis and negative appendectomy. For the first time, age is shown to be related to the rate of complicated appendicitis as a continuous variable rather than simply an extreme. Patients with complicated appendicitis still stay in the hospital longer, and there is a large cost difference as a result.

Comparison of pediatric appendectomy outcomes between pediatric surgeons and general surgery residents

BackgroundAppendectomy is the most common urgent procedure in children, and surgical outcomes may be affected by the surgeon's experience. This study's aim is to compare appendectomy outcomes performed by pediatric surgeons (PSs) and general surgery residents (GSRs). Materials and methodsA retrospective review of all patients younger than 16y treated for appendicitis at two different campuses of the same institution during the years 2008–2009 was performed. Appendectomies were performed by PS in one campus and GSR in the other. Primary end points included postoperative morbidity and hospital length of stay. ResultsDuring the study period, 246 (61%) patients were operated by senior GSR (postgraduate year 5–7) versus 157 (39%) patients by PS. There was no significant difference in patients' characteristics at presentation to the emergency room and the rate of appendeceal perforation (11% versus 15%, P=0.32), and noninfectious appendicitis (5% versus 5% P=0.78) also was similar. Laparoscopic surgery was performed more commonly by GSR (16% versus 9%, P=0.02) with shorter operating time (54±1.5 versus 60±2.1, P=0.01). Interestingly, the emergency room to operating room time was shorter for GSR group (419±14 versus 529±24min, P<0.001). The hospital length of stay was shorter for the GSR group (4.0±0.2 versus 4.5±0.2, P=0.03), and broad-spectrum antibiotics were used less commonly (20% versus 53%, P<0.0001) and so was home antibiotics continuation (13% versus 30%, P<0.0001). Nevertheless, postoperative complication rate was similar (5% versus 7%, P=0.29) and so was the rate of readmissions (2% versus 5%, P=0.52). ConclusionsThe results of this study suggest that the presence of a PS does not affect the outcomes of appendectomies.

Diagnostic Imaging and Negative Appendectomy Rates in Children: Effects of Age and Gender

Diagnostic imaging is often used in the evaluation of children with possible appendicitis. The utility of imaging may vary according to a patient's age and gender. The objectives of this study were (1) to examine the use of computed tomography (CT) and ultrasound for age and gender subgroups of children undergoing an appendectomy; and (2) to study the association between imaging and negative appendectomy rates (NARs) among these subgroups. Retrospective review of children presenting to 40 US pediatric emergency departments from 2005 to 2009 (Pediatric Health Information Systems database). Children undergoing an appendectomy were stratified by age and gender for measuring the association between ultrasound and CT use and the outcome of negative appendectomy. A total of 8 959 155 visits at 40 pediatric emergency departments were investigated; 55 227 children had appendicitis. The NAR was 3.6%. NARs were highest for children younger than 5 years (boys 16.8%, girls 14.6%) and girls older than 10 years (4.8%). At the institutional level, increased rates of diagnostic imaging (ultrasound and/or CT) were associated with lower NARs for all age and gender subgroups other than children younger than 5 years, The NAR was 1.2% for boys older than 5 years without any diagnostic imaging. The impact of diagnostic imaging on negative appendectomy rate varies by age and gender. Diagnostic imaging for boys older than 5 years with suspected appendicitis has no meaningful impact on NAR. Diagnostic strategies for possible appendicitis should incorporate the risk of negative appendectomy by age and gender.

Laparoscopic Appendectomy Outcomes on the Weekend and During the Week are no Different: A National Study of 151,774 Patients

The "weekend effect" is defined as increased morbidity and mortality for patients admitted on weekends compared with weekdays. It has been observed for several diseases, including myocardial infarction and renal insufficiency; however, it has not yet been investigated for laparoscopic appendectomy in acute appendicitis-one of the most prevalent surgical diagnoses. The present study is based on the Nationwide Inpatient Sample (NIS) from 1999 to 2008. The following outcomes were compared between patients undergoing laparoscopic appendectomy for acute appendicitis admitted on weekdays versus weekends: severity of appendicitis, intraoperative and postoperative complications, conversion rate, in-hospital mortality, and length of hospital stay. Unadjusted and risk-adjusted generalized linear regression analyses were performed. Overall, 151,774 patients were included, mean age was 39.6 years, 52.6% (n = 79,801) were male, and 25.3% (n = 38,317) were admitted on weekends. After risk adjustment, the conversion rate was lower [odds ratio (OR): 0.94, p = 0.004, number needed to harm (NNH): 244], whereas pulmonary complications (OR: 1.12, p = 0.028, NNH: 649) and reoperations (OR: 1.21, p = 0.013, NNH: 1,028) were slightly higher on weekends than on weekdays. Overall postoperative complications (OR: 1.03, p = 0.24), mortality (OR: 1.37, p = 0.075) and length of hospital stay (mean on weekday: 2.00 days, weekends: 2.01 days, p = 0.29) were not statistically different. The present investigation provides evidence that no clinically significant "weekend effect" for patients undergoing laparoscopic appendectomy exists. Therefore, hospital or staffing policy changes are not justified based on the findings from this large national study.

Comparison of Pediatric Appendectomy Outcomes Between Pediatric Surgeons and General Surgery Residents

Comparison of Pediatric Appendectomy Outcomes Between Pediatric Surgeons and General Surgery Residents