Matthew C Hernandez1, Stephanie F Polites2, Johnathon M Aho3, Nadeem N Haddad2, Victor Y Kong4, Humza Saleem2, John L Bruce4, Grant L Laing4, Damian L Clarke4, Martin D Zielinski2. 1. Division of Trauma Critical Care and General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: hernandez.matthew@mayo.edu. 2. Division of Trauma Critical Care and General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN. 3. Division of Trauma Critical Care and General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN; Biomedical Engineering and Physiology, Mayo Clinic College of Medicine, Rochester, MN. 4. Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-Zulu Natal, South Africa.
Abstract
OBJECTIVE: To assess whether the American Association for the Surgery of Trauma (AAST) grading system accurately corresponds with appendicitis outcomes in a US pediatric population. STUDY DESIGN: This single-institution retrospective review included patients <18 years of age (n = 331) who underwent appendectomy for acute appendicitis from 2008 to 2012. Demographic, clinical, procedural, and follow-up data (primary outcome was measured as Clavien-Dindo grade of complication severity) were abstracted. AAST grades were generated based on intraoperative findings. Summary, univariate, and multivariable regression analyses were performed to compare AAST grade and outcomes. RESULTS: Overall, 331 patients (46% female) were identified with a median age of 12 (IQR, 8-15) years. Appendectomy was laparoscopic in 90% and open in 10%. AAST grades included: Normal (n = 13, 4%), I (n = 152, 46%), II (n = 90, 27%), III (n = 43, 13%), IV (n = 24 7.3%), and V (n = 9 2.7%). Increased AAST grade was associated with increased Clavien-Dindo severity, P =.001. The overall complication rate was 13.6% and was comprised by superficial surgical site infection (n = 13, 3.9%), organ space infection (n = 15, 4.5%), and readmission (n = 17, 5.1%). Median duration of stay increased with AAST grade (P < .0001). Nominal logistic regression identified the following as predictors of any complication (P < .05): AAST grade and febrile temperature at admission. CONCLUSIONS: The AAST appendicitis grading system is valid in a single-institution pediatric population. Increasing AAST grade incrementally corresponds with patient outcomes including increased risk of complications and severity of complications. Determination of the generalizability of this grading system is required.
OBJECTIVE: To assess whether the American Association for the Surgery of Trauma (AAST) grading system accurately corresponds with appendicitis outcomes in a US pediatric population. STUDY DESIGN: This single-institution retrospective review included patients <18 years of age (n = 331) who underwent appendectomy for acute appendicitis from 2008 to 2012. Demographic, clinical, procedural, and follow-up data (primary outcome was measured as Clavien-Dindo grade of complication severity) were abstracted. AAST grades were generated based on intraoperative findings. Summary, univariate, and multivariable regression analyses were performed to compare AAST grade and outcomes. RESULTS: Overall, 331 patients (46% female) were identified with a median age of 12 (IQR, 8-15) years. Appendectomy was laparoscopic in 90% and open in 10%. AAST grades included: Normal (n = 13, 4%), I (n = 152, 46%), II (n = 90, 27%), III (n = 43, 13%), IV (n = 24 7.3%), and V (n = 9 2.7%). Increased AAST grade was associated with increased Clavien-Dindo severity, P =.001. The overall complication rate was 13.6% and was comprised by superficial surgical site infection (n = 13, 3.9%), organ space infection (n = 15, 4.5%), and readmission (n = 17, 5.1%). Median duration of stay increased with AAST grade (P < .0001). Nominal logistic regression identified the following as predictors of any complication (P < .05): AAST grade and febrile temperature at admission. CONCLUSIONS: The AAST appendicitis grading system is valid in a single-institution pediatric population. Increasing AAST grade incrementally corresponds with patient outcomes including increased risk of complications and severity of complications. Determination of the generalizability of this grading system is required.
Authors: Katherine J Baxter; Heather L Short; Curtis D Travers; Kurt F Heiss; Mehul V Raval Journal: Pediatr Surg Int Date: 2018-10-13 Impact factor: 1.827
Authors: Salomone Di Saverio; Mauro Podda; Belinda De Simone; Marco Ceresoli; Goran Augustin; Alice Gori; Marja Boermeester; Massimo Sartelli; Federico Coccolini; Antonio Tarasconi; Nicola De' Angelis; Dieter G Weber; Matti Tolonen; Arianna Birindelli; Walter Biffl; Ernest E Moore; Michael Kelly; Kjetil Soreide; Jeffry Kashuk; Richard Ten Broek; Carlos Augusto Gomes; Michael Sugrue; Richard Justin Davies; Dimitrios Damaskos; Ari Leppäniemi; Andrew Kirkpatrick; Andrew B Peitzman; Gustavo P Fraga; Ronald V Maier; Raul Coimbra; Massimo Chiarugi; Gabriele Sganga; Adolfo Pisanu; Gian Luigi De' Angelis; Edward Tan; Harry Van Goor; Francesco Pata; Isidoro Di Carlo; Osvaldo Chiara; Andrey Litvin; Fabio C Campanile; Boris Sakakushev; Gia Tomadze; Zaza Demetrashvili; Rifat Latifi; Fakri Abu-Zidan; Oreste Romeo; Helmut Segovia-Lohse; Gianluca Baiocchi; David Costa; Sandro Rizoli; Zsolt J Balogh; Cino Bendinelli; Thomas Scalea; Rao Ivatury; George Velmahos; Roland Andersson; Yoram Kluger; Luca Ansaloni; Fausto Catena Journal: World J Emerg Surg Date: 2020-04-15 Impact factor: 5.469
Authors: Matthew C Hernandez; Arianna Birindelli; John L Bruce; Johannes J P Buitendag; Victory Y Kong; Mircea Beuran; Johnathon M Aho; Ionut Negoi; Damian L Clarke; Salomone Di Saverio; Martin D Zielinski Journal: World J Surg Date: 2018-11 Impact factor: 3.352