Andrew Wang1, James M Prieto1, Erin Ward2, Stephen Bickler3, Marion Henry1, Karen Kling3, Hariharan Thangarajah3, Romeo Ignacio4. 1. Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA. 2. Department of Surgery, School of Medicine, University of California, La Jolla, CA 92093, USA. 3. Division of Pediatric Surgery, Rady Children's Hospital, San Diego, CA 92123, USA. 4. Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA. Electronic address: romeo.c.ignacio.mil@mail.mil.
Abstract
BACKGROUND/ OBJECTIVES: An 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). METHODS: The 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). RESULTS: Fifty-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). CONCLUSION: There 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 STUDY: retrospective comparative study. LEVEL OF EVIDENCE: III.
BACKGROUND/ OBJECTIVES: An 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). METHODS: The 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). RESULTS: Fifty-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). CONCLUSION: There 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 STUDY: retrospective comparative study. LEVEL OF EVIDENCE: III.
Authors: Mauro Ariel Capparelli; Victor Hugo Ayarzabal; Esteban Tomas Halac; Horacio Alberto Questa; Maria Julia Minetto; Guillermo Cervio; Marcelo Eugenio Barrenechea Journal: Pediatr Surg Int Date: 2021-05-31 Impact factor: 1.827
Authors: Lorraine I Kelley-Quon; L Grier Arthur; Regan F Williams; Adam B Goldin; Shawn D St Peter; Alana L Beres; Yue-Yung Hu; Elizabeth J Renaud; Robert Ricca; Mark B Slidell; Amy Taylor; Caitlin A Smith; Doug Miniati; Juan E Sola; Patricia Valusek; Loren Berman; Mehul V Raval; Ankush Gosain; Matthew B Dellinger; Stig Sømme; Cynthia D Downard; Jarod P McAteer; Akemi Kawaguchi Journal: J Pediatr Surg Date: 2020-10-06 Impact factor: 2.545