Rate Of Perforated Appendicitis Research Articles

Role of Red Blood Cell Distribution Width (RDW) and Neutrophil Lymphocyte Ratio (NLR) in Diagnosis of Appendicitis in Paediatric Patients in H. Adam Malik Medan Central General Hospital

Acute appendicitis in paediatric patient is among the causal of abdominal emergency which requires immediate operation (Victor, et al, 2012; Ballester et al., 2009; Huckins et al., 2013). The incidence of acute appendicitis in paediatric patient in the world ranges from 1 to 8 % of all pediatric patients coming to the Emergency Department (ED) with acute abdominal pain (Jangra et al., 2013). Appendicitis is rare in children under 5 years, and very rare in the first year of life. In some instances, boys are more than girls around 55% to 65% of patients (Stevenson, Edward, 2003). The incidence rate of perforated appendicitis in the age group of children is about 30% to 40%. Appendicitis in the neonate is very rare, and the surgeon should be careful of the accompanying conditions, such as Hirschsprung’s disease and necrotic enterocolitis. (Stevenson, Edward, 2003).

Association of Health Care Utilization With Rates of Perforated Appendicitis in Children 18 Years or Younger

The pediatric perforated appendix rate is a quality metric measured by the Agency for Healthcare Research and Quality (AHRQ) that reflects access to care. The association of health care utilization prior to presentation with appendicitis is unknown. To determine whether increased health care utilization prior to presentation with appendicitis is associated with lower perforated appendicitis rates in children. Retrospective cohort study of privately insured children drawn from large employer and insurance company administrative data found in the Truven MarketScan national insurance claims database. Cases of appendicitis were identified among 38 348 children 18 years or younger from January 1, 2010, through December 31, 2013, with corresponding primary health care encounters from January 1, 2009, through December 31, 2012. In all, 19 109 eligible children were identified using International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes for appendicitis after excluding those patients who did not have continuous insurance coverage during the study period. Statistical analysis was performed from September 1, 2016, to October 15, 2017. Health care utilization was determined by the number of outpatient clinic encounters for each patient in the 1 to 12 months before presentation with appendicitis. Perforated appendicitis was defined according to the AHRQ by using ICD-9 codes for perforation and hospital length of stay of 3 or more days. Logistic regression models were used for perforated appendicitis after adjustment for age, sex, income, gastrointestinal comorbidities, geographic region, and insurance type. We identified 38 348 children 18 years or younger with ICD-9 diagnosis codes for appendicitis, and 19 109 children remained for analysis after applying exclusion criteria. Of these, 11 422 were boys (59.8%); the mean (SD) age was 12.4 (3.9) years. Of the 19 109 children identified who underwent appendectomy, 5509 (28.8%) presented with perforated appendicitis. Children with perforation had lower outpatient health care utilization in the year before presentation compared with those diagnosed with acute appendicitis (4554 of 5509 children [82.7%] vs 11 937 of 13 600 [87.8%]; P < .001). In the adjusted model, outpatient health care utilization before presentation was associated with lower odds of perforated appendicitis (odds ratio [OR], 0.63; 95% CI, 0.58-0.69; P < .001). This association increased with visit frequency in the year before presentation (OR, 0.86; 95% CI, 0.77-0.95 for 1-2 visits, P = .003; OR, 0.61; 95% CI, 0.55-0.67 for 3-6 visits, P < .001; and OR, 0.43; 95% CI, 0.38-0.48 for ≥7 visits [5-18 years], P < .001). Covariates associated with perforation included younger age, geographic region, family income, and higher out-of-pocket insurance plans. Among insured children 18 years or younger, increased health care utilization was associated with lower rates of perforated appendicitis. Primary health care relationships may facilitate timely presentation or serve as a marker for health-related self-efficacy, thereby contributing to outcomes for acute surgical conditions.

LAPAROSCOPIC APPENDECTOMY DOES NOT INCREASE THE RATE OF NEGATIVE APPENDECTOMY along with a lower rate of perforated appendicitis - RESULTS IN 1899 PATIENTS at Zagreb UHC.

SUMMARY – Laparoscopic appendectomy is the method of choice of many professional societies owing to its many advantages. The question arises whether surgeons urge more easily to laparoscopic exploration due to its less invasiveness, faster recovery and adequate exploration of the entire abdominal cavity than to observation in unequivocal cases. This retrospective analysis (2009-2016) included 1899 patients undergoing laparoscopic (lap) or gridiron intra-abdominal approach treated at Zagreb University Hospital Centre. The analysis included total negative appendectomy, negative-negative appendectomy (normal appendix and no other pathology found), and negative-positive appendectomy (normal appendix but another pathology found) in children (≤16 years) and adults. There was no statistically significant difference in the rates of negative appendectomy (children) – lap vs. open (p=0.24); negative appendectomy (adults) – lap vs. open (p=0.15); negative-negative appendectomy (children) – lap vs. open (p=0.36); negative-negative appendectomy (adults) – lap vs. open (p=0.21); negative-positive appendectomy (children) – lap vs. open (p=0.53); negative-positive appendectomy (adults) – lap vs. open (p=0.56); and laparoscopy group negative appendectomy in children vs. adults (p=0.56). There was a statistically significantly higher perforation rate with the open approach in total (p<0.0001), in children (p<0.0001) and in adults (p=0.02). There was no statistically significant difference between adults and children in the perforation rate with laparoscopic approach (p=0.24) and perforation rate with open approach (p=0.29). Results confirmed that there was no statistically significant difference in the rate of negative appendectomy in all subgroups. It is concluded that laparoscopic appendectomy should be offered as the method of choice in any patient population with suspicion of acute appendicitis.

Perforated appendicitis in patients with schizophrenia: a retrospective cohort study

ObjectiveAltered pain sensitivity may affect the outcome of appendicitis in patients with schizophrenia. We aimed to compare the prevalence of perforation in appendicitis between patients with and without schizophrenia.DesignRetrospective cohort...

Negative Appendectomy: Clinical and Economic Implications

Historically, performing a negative appendectomy (NA) was justified to reduce the incidence of perforation. Furthermore, it is also believed that NA is associated with minimal morbidity and cost. The purpose of this study was to evaluate the frequency, clinical characteristics, and economic implications of NA. We reviewed the inpatient admissions on 274,405 patients who underwent nonincidental appendectomy as their primary procedure from the California State Inpatient Databases (2005-2011). Overall, 96.9 per cent had appendicitis (nonperforated = 73.1%, perforated = 23.8% and 3.1%) had NA. NA rates decreased steadily from 4.2 per cent in 2005 to 2.5 per cent in 2011 (P < 0.01). The rates of appendectomy for perforated appendicitis rates also decreased slightly from 25.3 to 23.3 per cent during this time (P = <0.01). Multivariate regression showed that female gender, African American race, and public insurance were all associated with increased NA rates. Compared with patients with appendectomy for nonperforated appendicitis, NA was associated with longer length of stay (NA = 3.2 days vs nonperforated = 1.7 days), higher median cost per admission (NA = $8626 vs nonperforated = $7605), and higher morbidity (4.7 vs 1.9%), all P < 0.01. Contrary to classic justification for NA, we did not find an inverse association of appendectomy for perforated appendicitis and NA at the hospital level. In conclusion, NA is associated with substantial clinical and financial burden, while having no apparent impact on lowering the rate of appendectomy for perforated appendicitis.

Diabetes is associated with perforated appendicitis: evidence from a population-based study

BackgroundThe purpose of this study was to investigate the relationship between perforated appendicitis and patient with diabetes using a population-based data set. MethodsThis study used data from the Longitudinal Health Insurance Database 2005 in Taiwan. We identified 4,806 patients hospitalized with acute appendicitis. The independent variable was whether a patient had ever received a diagnosis of diabetes before the index hospitalization. We performed a conditional logistic regression model to explore the odds ratio and its corresponding 95% confidence interval of perforated appendicitis. ResultsRates of perforated appendicitis for patients with and those without diabetes were 46.2% and 28.3%, respectively. A chi-square test revealed that there was a significant difference in rates of perforated appendicitis between patients with and those without diabetes (P < .001). The conditional logistic regression model revealed that the adjusted odds ratio of perforated appendicitis for patients with diabetes was 1.35 (95% confidence interval = 1.11 to 1.65) compared with patients without diabetes. ConclusionsOur study demonstrated that a history of diabetes is an important factor with regard to the rate of perforated appendicitis.

Are Hospital Surgical Quality Teams Well Versed in Carrying out Quality and Process Improvement Initiatives: A Baseline Assessment of Quality Improvement Knowledge at 55 Illinois Hospitals

Berger, Elizabeth R. MD; O’Leary, Kevin J. MD; Johnson, Julie K. MSPH, PhD; Reinhart, Stephen P. MBA; Farrell, Paula R. RN; Yang, Anthony D. MD, FACS; Barsness, Katherine A. MD, FACS; Halverson, Amy L. MD, FACS; Thomas, Juliana M. MPH; Bilimoria, Karl Y. MD, FACS Author Information

Incidence of appendicitis according to region of origin in first- and second-generation immigrants and adoptees in Sweden. A cohort follow-up study

Background. Geographic variations in incidence of appendicitis and proportion of perforations suggest environmental or genetic etiological factors. We study incidence of appendicitis and proportion of perforations according to geographical origin in immigrants and international adoptees in Sweden. Methods. A cohort of 11,557,566 Swedish residents – 277,104 first- and 377,773 second-generation immigrants and 57,304 adoptees – was followed from 1988 till 2010. Differences in proportion of operation for perforated appendicitis and negative appendectomy and standardized incidence ratios (SIR) of perforated and non-perforated appendicitis associated with geographic origin was analyzed. Results. High incidence rates are seen in first- and second-generation immigrants from South America for perforated (SIR 1.58 and 1.81, respectively) and non-perforated appendicitis (SIR 1.18 and 1.22, respectively), and in adoptees from South America for non-perforated appendicitis (SIR 1.07). Low incidence rates are seen for perforated appendicitis in first-generation immigrants and adoptees from Asia (SIR 0.74 and 0.56, respectively), and for non-perforated appendicitis in immigrants from Africa and Asia (SIR 0.69 and 0.76 in first-generation, 0.51 and 0.74 in second-generation, respectively) and in adoptees from Asia (SIR 0.71). A high proportion of perforated appendicitis is associated with a low incidence rate of non-perforated appendicitis but no increase in the incidence rate of perforated appendicitis. Conclusions. The association of different incidence of appendicitis with geographic origin which remains over generations and is seen in adoptees suggest genetic etiologic factors. The proportion of perforation can be high without an increased incidence rate of perforation and is therefore an imperfect indicator of quality of care.

Predictors of appendiceal perforation in an equal access system

BackgroundDiscrepancies in socioeconomic factors have been associated with higher rates of perforated appendicitis. As an equal-access health care system theoretically removes these barriers, we aimed to determine if remaining differences in demographics, education, and pay result in disparate outcomes in the rate of perforated appendicitis. Materials and methodsAll patients undergoing appendectomy for acute appendicitis (November 2004–October 2009) at a tertiary care equal access institution were categorized by demographics and perioperative data. Rank of the sponsor was used as a surrogate for economic status. A multivariate logistic regression model was performed to determine patient and clinical characteristics associated with perforated appendicitis. ResultsA total of 680 patients (mean age 30 ± 16 y; 37% female) were included. The majority were Caucasian (56.4% [n = 384]; African Americans 5.6% [n = 38]; Asians 1.9% [n = 13]; and other 48.9% [n = 245]) and enlisted (87.2%). Overall, 6.4% presented with perforation, with rates of 6.6%, 5.8%, and 6.7% (P = 0.96) for officers, enlisted soldiers, and contractors, respectively. There was no difference in perforation when stratified by junior or senior status for either officers or enlisted (9.3% junior versus 4.40% senior officers, P = 0.273; 6.60% junior versus 5.50% senior enlisted, P = 0.369). On multivariate analysis, parameters such as leukocytosis and temperature, as well as race and rank were not associated with perforation (P = 0.7). Only age had a correlation, with individuals aged 66–75 y having higher perforation rates (odds ratio, 1.04; 95% confidence interval, 1.02–1.05; P < 0.001). ConclusionsIn an equal-access health care system, older age, not socioeconomic factors, correlated with increased appendiceal perforation rates.

Determinants of appendicitis outcomes in Canadian children

BackgroundOutcomes of appendicitis may be influenced by access to healthcare. We investigated the determinants of pediatric appendicitis outcomes in the single-payer Canadian healthcare system. MethodsChildren coded for urgent appendectomy by the Canadian Institute of Health Information during the period 2004–2010 were analyzed. Misdiagnosis rate, perforated appendicitis rate, and hospital stay were the outcomes studied. Analyzed variables included age, gender, domicile, socioeconomic status, surgeon’s specialty, hospital type, region, and operative approach. Logistic regression analysis was used to examine associations, and a quintile regression model examined the effect on median hospital stay. Results41,702 patients were studied. A higher rate of perforated appendicitis was associated with lower age [OR 2.66], male gender [OR 1.18], pediatric surgeon [OR 1.25], and treatment outside the Maritimes. A higher rate of misdiagnosis was associated with lower age [OR 1.53], female gender [OR 2.29], non-children’s hospital [OR 1.33], and western Canada [OR 1.22]. A significantly longer hospital stay was associated with open appendectomy, pediatric surgeon, and the Territories for simple appendicitis, and open appendectomy, pediatric surgeon, children’s hospital, and the Maritimes for perforated appendicitis. ConclusionsIn Canada, outcomes of pediatric appendicitis are associated with regional and treatment-level factors. Rural domicile and socioeconomic status do not affect outcomes.

Risk of perforation increases with delay in recognition and surgery for acute appendicitis

BackgroundAppendicitis remains a common indication for urgent surgical intervention in the United States, and early appendectomy has long been advocated to mitigate the risk of appendiceal perforation. To better quantify the risk of perforation associated with delayed operative timing, this study examines the impact of length of inpatient stay preceding surgery on rates of perforated appendicitis in both adults and children. MethodsThis study was a cross-sectional analysis using the National Inpatient Sample and Kids’ Inpatient Database from 1988–2008. We selected patients with a discharge diagnosis of acute appendicitis (perforated or nonperforated) and receiving appendectomy within 7 d after admission. Patients electively admitted or receiving drainage procedures before appendectomy were excluded. We analyzed perforation rates as a function of both age and length of inpatient hospitalization before appendectomy. ResultsOf 683,590 patients with a discharge diagnosis of appendicitis, 30.3% were recorded as perforated. Over 80% of patients underwent appendectomy on the day of admission, approximately 18% of operations were performed on hospital days 2–4, and later operations accounted for <1% of cases. During appendectomy on the day of admission, the perforation rate was 28.8%; this increased to 33.3% for surgeries on hospital day 2 and 78.8% by hospital day 8 (P<0.001). Adjusted for patient, procedure, and hospital characteristics, odds of perforation increased from 1.20 for adults and 1.08 for children on hospital day 2 to 4.76 for adults and 15.42 for children by hospital day 8 (P<0.001). ConclusionsGreater inpatient delay before appendectomy is associated with increased perforation rates for children and adults within this population-based study. These findings align with previous studies and with the conventional progressive pathophysiologic appendicitis model. Randomized prospective studies are needed to determine which patients benefit from nonoperative versus surgically aggressive management strategies for acute appendicitis.

Volume-Outcome Relation for Acute Appendicitis: Evidence from a Nationwide Population-Based Study

BackgroundAlthough procedures like appendectomy have been studied extensively, the relative importance of each surgeon's surgical volume-to-ruptured appendicitis has not been explored. The purpose of this study was to investigate the rate of ruptured appendicitis by surgeon-volume groups as a measure of quality of care for appendicitis by using a nationwide population-based dataset.MethodsWe identified 65,339 first-time hospitalizations with a discharge diagnosis of acute appendicitis (International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes 540, 540.0, 540.1 and 540.9) between January 2007 and December 2009. We used “whether or not a patient had a perforated appendicitis” as the outcome measure. A conditional (fixed-effect) logistic regression model was performed to explore the odds of perforated appendicitis among surgeon case volume groups.ResultsPatients treated by low-volume surgeons had significantly higher morbidity rates than those treated by high-volume (28.1% vs. 26.15, p<0.001) and very-high-volume surgeons (28.1% vs. 21.4%, p<0.001). After adjusting for surgeon practice location, and teaching status of practice hospital, and patient age, gender, and Charlson Comorbidity Index, and hospital acute appendicitis volume, patients treated by low-volume surgeons had significantly higher rates of perforated appendicitis than those treated by medium-volume surgeons (OR = 1.09, p<0.001), high-volume surgeons (OR = 1.16, p<0.001), or very-high-volume surgeons (OR = 1.54, p<0.001).ConclusionOur study suggested that surgeon volume is an important factor with regard to the rate of ruptured appendicitis.

Factors associated with imaging modality choice in children with appendicitis

BackgroundThe aim of this study was to evaluate a cohort of children undergoing imaging prior to appendectomy in order to identify factors that were associated with undergoing computed tomography (CT) alone as compared to ultrasound (US) alone or US and CT. Materials and methodsThe Kids' Inpatient Database was queried for children 1–18 y of age with imaging reported. Logistic regression models identified factors associated with CT-alone imaging modality. ResultsThere were 6519 patients (69.5%) who underwent CT alone, 2076 (22.1%) who underwent US alone, and 782 (8.4%) who underwent US and CT. The negative appendectomy rates were higher for US alone (6.5%) and US and CT (6.6%) compared to the CT alone group (3.6%, P < 0.001). The perforated appendicitis rates were highest for the US and CT group (36.3%) compared to the CT alone group (31.8%) and the US alone group (29.8%, P = 0.004). Older patients were more likely to undergo CT alone compared to younger patients (odds ratio [OR] 1.44, 95% confidence interval [CI] 1.26–1.64). Girls were less likely to undergo CT alone compared to boys (OR 0.51, 95% CI 0.46–0.56). Hospital factors associated with lower CT-alone imaging included children's centers (OR 0.46, 95% CI 0.41–0.52), teaching hospitals (OR 0.53, 95% CI 0.48–0.60), and urban location (OR 0.40, 95% CI 0.32–0.49). ConclusionsThough patient factors such as age and sex influence imaging use, children's centers are associated with lower CT-alone imaging compared to non–children's centers. As focus increases on limiting CT use in children, opportunities for improvement based on hospital factors exist.

Does Laparoscopic Appendectomy Impart an Advantage over Open Appendectomy in Elderly Patients?

The use of laparoscopy in the elderly has been increasing in recent years. The data comparing laparoscopic (LA) with open appendectomy (OA) in elderly patients are minimal. We evaluated outcomes of LA versus OA in perforated and nonperforated appendicitis in elderly patients (aged ≥ 65 years). Using the Nationwide Inpatient Sample database, clinical data of elderly patients who underwent LA and OA for suspected acute appendicitis were evaluated from 2006 to 2008. A total of 65,464 elderly patients underwent urgent appendectomy during this period. The rate of perforated appendicitis was twice as high in elderly patients (50 vs. 25%, p < 0.01) and rate of LA in elderly patients was lower (52 vs. 63%, p < 0.01) compared with patients younger than aged 65 years. Utilization of LA increased 24% from 46.5% in 2006 to 57.8% in 2008 (p < 0.01). In elderly patients with acute nonperforated appendicitis, LA had lower overall complication rate (15.82 vs. 23.49%, p < 0.01), in-hospital mortality (0.39 vs. 1.31%, p < 0.01), hospital charges ($30,414 vs. $34,095, p < 0.01), and mean length of stay (3.0 vs. 4.8 days, p < 0.01) compared with OA. Additionally, in perforated appendicitis in elderly patients, LA was associated with lower overall complication rate (36.27 vs. 46.92%, p < 0.01), in-hospital mortality (1.4 vs. 2.63%, p < 0.01), mean hospital charges ($43,339 vs. $57,943, p < 0.01), and shorter mean LOS (5.8 vs. 8.7 days, p < 0.01). Laparoscopic appendectomy can be performed safely with significant advantages compared with open appendectomy in the elderly and should be considered the procedure of choice for perforated and nonperforated appendicitis in these patients.

Comparison of Outcomes of Laparoscopic Versus Open Appendectomy in Children: Data from The Nationwide Inpatient Sample (NIS), 2006–2008

The benefits of laparoscopic appendectomy (LA) remain undefined as compared to open appendectomy (OA) in children, particularly in cases of perforated appendicitis. The purpose of the present study was to evaluate the outcomes of LA versus OA in perforated and nonperforated appendicitis in children. Using the Nationwide Inpatient Sample database, we evaluated the clinical data of children (<18 years old) who underwent LA and OA from 2006 to 2008. Incidental and elective appendectomies were excluded. A total of 212,958 children underwent urgent appendectomy in the United States during these years. The overall rate of perforated appendicitis was 27.7, and 56.9% of all cases were performed laparoscopically. In nonperforated cases, LA was associated with comparable overall complication rate (LA: 2.56 vs. OA: 2.66%; p = 0.26), shorter length of hospital stay (LOS, LA: 1.6 vs. OA: 2.0 days; p < 0.01), comparable mortality (LA: 0.01 vs. OA: 0.02%; p = 0.25); and higher hospital charges (LA: $20,328 vs. OA: $16,830; p < 0.01) compared to OA. In perforated cases, LA had a lower overall complication rate (LA: 16.03 vs. OA: 18.07%; p < 0.01), shorter LOS (LA: 5.1 vs. OA: 5.8 days; p < 0.01), lower mortality (LA: 0.0% versus OA: 0.06%; p < 0.01), and similar hospital charges (LA: $33,361 versus OA: $33, 662; p = 0.71) compared to OA. LA is safe in children with acute perforated and nonperforated appendicitis, and is associated with shorter hospital stay than OA. The laparoscopic approach is associated with lower morbidity and mortality in perforated cases. However, in nonperforated cases, these benefits are modest and are associated with higher hospital charges.

Negative appendicectomy and perforation rates in patients undergoing laparoscopic surgery for suspected appendicitis

Despite widespread use of imaging technologies including ultrasonography and computed tomography, rates of negative appendicectomy and perforated appendicitis remain high. This trend analysis examined whether rates of negative appendicectomy and perforated appendicitis have decreased over time, and sought to evaluate clinical predictors associated with negative appendicectomy and perforated appendicitis. This analysis was based on the prospective database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS). All patients aged 12 years and over undergoing emergency laparoscopic appendicectomy between 1995 and 2006 were included. Unadjusted and risk-adjusted logistic regression analyses were performed. A total of 7964 patients underwent laparoscopic appendicectomy, of whom 7452 (93.6 per cent) had acute appendicitis and 512 (6.4 per cent) had a macroscopically normal appendix. Perforation occurred in 1230 (16.5 per cent) of those with appendicitis. In multivariable analysis, younger age (12-18 years), female sex, absence of local or generalized peritonitis and an early point during the study period were significant predictors of negative appendicectomy. For perforated appendicitis, significant predictors included age over 36 years, presence of localized or generalized peritonitis, and high American Society of Anesthesiologists grade. The rate of negative appendicectomy decreased from 12.7 per cent in 1995 to 2.8 per cent in 2006, there being a significant reduction in both unadjusted and risk-adjusted analyses (P < 0.001 for trend). In adjusted analyses, the rate of perforated appendicitis did not increase significantly over time. The rate of negative appendicectomy decreased over time, without an accompanying increase in perforated appendicitis. The risk of having a negative appendicectomy was highest in girls aged 12-18 years without local or generalized peritonitis during the early study period, whereas perforation was associated with age over 36 years, presence of localized or generalized peritonitis, and greater co-morbidity. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Provider Density and Health System Facility Factors and Their Relationship to Rates of Pediatric Perforated Appendicitis in US Counties

To examine whether density of providers or health care facility factors have a significant effect on the rates of perforated appendicitis in the pediatric population. A retrospective database analysis. Data were linked to the Area Resource File to determine if there was an association between perforated appendicitis and density of provider and facility factors. The National Inpatient Sample database and the Kids' Inpatient Database from 1988 to 2005. All patients included had an age at admission of younger than 18 years and were selected by International Classification of Diseases, Ninth Revision code as having perforated appendicitis (540.0 or 540.1) or acute appendicitis (540.9). Main Outcome Measure Odds ratio of perforated appendicitis to acute appendicitis by county-level density of provider and health care facility factors. The odds ratio of perforated appendicitis to acute appendicitis when stratified by quartiles of increasing density of providers and facility-level factors was statistically significant only for the highest-density quartile of pediatricians (odds ratio = 0.88; 95% confidence interval = 0.78-0.99). Increasing geographic density of pediatricians was associated with a decreasing trend in the odds ratio of perforated appendicitis, with a statistically significant protective effect observed in the highest-density quartile of pediatricians. The density of all other provider and health care facility factors analyzed did not demonstrate a significant association with the rates of perforated appendicitis.

Appendicitis outcomes are better at resident teaching institutions: a multi-institutional analysis

Background This study compared the outcomes of appendicitis between teaching and nonteaching institutions. Methods A retrospective review was performed of all appendicitis patients aged >18 years from 1998 to 2007. The outcomes from 2 teaching institutions (each with its own general surgery residency program) were compared with those from 11 nonteaching institutions. Study outcomes included postoperative morbidity and length of hospitalization. Results A total of 3,242 patients were treated at the teaching institutions (mean age, 41 years; 61% men) and 14,483 at the nonteaching institutions (mean age, 38 years; 54% men). The perforated appendicitis rate was 29% at the teaching institution and 28% at the nonteaching institutions ( P = .20). For nonperforated appendicitis, there was no difference in the incidence of wound infection between the teaching and nonteaching institutions (2.7% vs 2.3%, P = .30). There was a lower rate of abscess drainage (.4% vs 1%, P = .02), a lower readmission rate (1.7% vs 3.5%, P < .0001), and shorter lengths of stay (1.7 ± 1.5 vs 1.8 ± 1.6 days, P = .002) at teaching institutions. For perforated appendicitis, there were also lower rates of wound infection (4.8% vs 7%, P = .03), abscess drainage (4.9% vs 10%, P < .0001), and need for readmission (4.2% vs 8.4%, P < .0001) at the teaching hospitals. The lengths of stay were similar (5.0 ± 4.2 vs 5.2 ± 3.1 days, P = .30). Use of laparoscopy was lower and nonoperative management of perforated appendicitis higher at the teaching hospitals. Conclusions Teaching institutions were more likely to perform appendectomy using an open technique and to manage perforated appendicitis nonoperatively. Infectious complications and readmission rates for both perforated and nonperforated appendicitis were lower at teaching institutions.

A Multi-Institutional Comparison of Pediatric Appendicitis Outcomes Between Teaching and Nonteaching Hospitals

In this era of heightened emphasis on patient outcomes, it is important to document the effect of residents acting as the surgeon for a surgical procedure. This study compares the outcomes of appendicitis between teaching and nonteaching institutions. A retrospective review from 1998 to 2007 was performed. The study outcomes were postoperative morbidity and length of hospitalization (LOH). Data were analyzed using Wilcoxon rank-sum test and χ(2) analysis. Two teaching institutions (each with its own General Surgery residency program) were compared with 10 nonteaching institutions. A total of 1472 patients were treated at the teaching institutions (mean age = 9.8 years, male = 63%), and 6431 patients were treated at the nonteaching institutions (mean age = 10.8 years, male = 62%). The perforated appendicitis rate was 37% at the teaching institutions and 30% at the nonteaching institutions (p < 0.0001). For nonperforated appendicitis, a higher rate of laparoscopic appendectomy was found at the nonteaching institutions versus the teaching institutions (39% vs 52%, p < 0.0001). Otherwise, no difference was noted in the rate of wound infection, postoperative abscess drainage, or readmissions between the institutions. The LOH was also similar. For perforated appendicitis, a lower wound infection (5.2% vs 8.2%, p = 0.03) and readmission (5.6% vs 9.7%, p = 0.004) rate was found at the teaching institutions. No differences were discovered in the incidence of postoperative abscess drainage or LOH between teaching versus nonteaching hospitals. Perforated appendicitis was managed nonoperatively more commonly at the teaching institutions (7.4% vs 12.8%, p = 0.0001). Postoperative morbidity was similar in children with nonperforated appendicitis and lower in children with perforated appendicitis at teaching institutions. LOH was similar between teaching and nonteaching institutions. Overall, the presence of surgical trainees had no adverse impact on the quality of care for children with appendicitis.

Comparison of Pediatric Laparoscopic Appendectomy Outcomes Between Teaching and Nonteaching Hospitals: A Multi-Institutional Study

With heightened emphasis on patient safety, it is important to document the effect of residents acting as the surgeon. This study compares the outcomes of laparoscopic appendectomy (LA) in children between teaching and nonteaching institutions. A retrospective review of all patients <18 years undergoing LA for appendicitis over a 10-year period was performed. The outcomes from 2 teaching institutions were compared with 10 nonteaching institutions. Study outcomes included postoperative morbidity (wound infection, abscess drainage, and readmission) and length of hospitalization (LOH). Five hundred forty-two patients were treated at the teaching institution (mean age = 11 years, 62% male) and 3012 at the nonteaching institution (mean age = 13 years, 60% male). The perforated appendicitis rate was 33% at the teaching institution and 22% at the nonteaching institution (P < 0.0001). In patients with nonperforated appendicitis, rates of wound infection, abscess drainage, and readmission were similar between the institutions. However, for perforated appendicitis, rates of wound infection, abscess drainage, and readmission were all lower at the teaching institutions. LOH was longer at the teaching institutions for both nonperforated and perforated appendicitis. The morbidity for LA was significantly lower in children with perforated appendicitis at the teaching institutions, whereas morbidity for nonperforated appendicitis was similar. LOH was longer in the teaching institutions. Overall, the presence of surgical trainees had minimal adverse impact on the outcomes of LA in children with appendicitis.