Danielle B Cameron1, Regan Williams2, Yimin Geng3, Ankush Gosain4, Meghan A Arnold5, Yigit S Guner6, Martin L Blakely7, Cynthia D Downard8, Adam B Goldin9, Julia Grabowski10, Dave R Lal11, Roshni Dasgupta12, Robert Baird13, Robert L Gates14, Julia Shelton15, Tim Jancelewicz4, Shawn J Rangel1, Mary T Austin16. 1. Department of Surgery, Boston Children's Hospital, Boston, MA. 2. Department of Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN. Electronic address: rfwillia@uthsc.edu. 3. University of Texas, MD Anderson Cancer Center, Houston, TX. 4. Department of Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN. 5. Department of Surgery, Section of Pediatric Surgery, University of Michigan, CS Mott Children's Hospital, Ann Arbor, MI. 6. Department of Surgery, University of California Irvine and Division of Pediatric Surgery Children's Hospital of Orange County. 7. Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, TN. 8. Division of Pediatric Surgery, Department of Surgery, University of Louisville, Louisville, KY. 9. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA. 10. Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL. 11. Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. 12. Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital. 13. Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, QC, Canada. 14. Division of Pediatric Surgery, Greenville Health System, Greenville, SC. 15. Division of Pediatric Surgery, University of Iowa Stead Family Children's Hospital, Iowa City, IA. 16. Division of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX.
Abstract
OBJECTIVE: The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to develop recommendations regarding time to appendectomy for acute appendicitis in children within the context of preventing adverse events, reducing cost, and optimizing patient/parent satisfaction. METHODS: The committee selected three questions that were addressed by searching MEDLINE, Embase, and the Cochrane Library databases for English language articles published between January 1, 1970 and November 3, 2016. Consensus recommendations for each question were made based on the best available evidence for both children and adults. RESULTS: Based on level 3-4 evidence, appendectomy performed within 24h of admission in patients with acute appendicitis does not appear to be associated with increased perforation rates or other adverse events. Based on level 4 evidence, time from admission to appendectomy within 24h does not increase hospital cost or length of stay (LOS). Data are currently limited to determine an association between the timing of appendectomy and parent/patient satisfaction. CONCLUSIONS: There is a paucity of high-quality evidence in the literature regarding timing of appendectomy for patients with acute appendicitis and its association with adverse events or resource utilization. Based on available evidence, appendectomy performed within the first 24h from presentation is not associated with an increased risk of perforation or adverse outcomes. TYPE OF STUDY: Systematic Review of Level 1-4 studies.
OBJECTIVE: The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to develop recommendations regarding time to appendectomy for acute appendicitis in children within the context of preventing adverse events, reducing cost, and optimizing patient/parent satisfaction. METHODS: The committee selected three questions that were addressed by searching MEDLINE, Embase, and the Cochrane Library databases for English language articles published between January 1, 1970 and November 3, 2016. Consensus recommendations for each question were made based on the best available evidence for both children and adults. RESULTS: Based on level 3-4 evidence, appendectomy performed within 24h of admission in patients with acute appendicitis does not appear to be associated with increased perforation rates or other adverse events. Based on level 4 evidence, time from admission to appendectomy within 24h does not increase hospital cost or length of stay (LOS). Data are currently limited to determine an association between the timing of appendectomy and parent/patient satisfaction. CONCLUSIONS: There is a paucity of high-quality evidence in the literature regarding timing of appendectomy for patients with acute appendicitis and its association with adverse events or resource utilization. Based on available evidence, appendectomy performed within the first 24h from presentation is not associated with an increased risk of perforation or adverse outcomes. TYPE OF STUDY: Systematic Review of Level 1-4 studies.
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