Carlos Theodore Huerta1, Andrew Sundin1, Antoine J Ribieras1, Rebecca Saberi1, Walter Ramsey1, Gareth Gilna1, Hallie J Quiroz1, Chad M Thorson1,2, Juan E Sola1,2, Eduardo A Perez3,4. 1. University of Miami Miller School of Medicine, Miami, FL, USA. 2. DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Leonard M. Miller School of Medicine, 1120 NW 14th Street, Suite 450K, Miami, FL, 33136, USA. 3. University of Miami Miller School of Medicine, Miami, FL, USA. eperez3@med.miami.edu. 4. DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Leonard M. Miller School of Medicine, 1120 NW 14th Street, Suite 450K, Miami, FL, 33136, USA. eperez3@med.miami.edu.
Abstract
BACKGROUND: The utility of incidental appendectomy, appendectomy during another index surgery in the absence of appendicitis, has not been evaluated in the pediatric population during cholecystectomy. This study sought to compare nationwide outcomes after cholecystectomy with incidental appendectomy in children. METHODS: Patients ≤ 18 years old who underwent cholecystectomy from 2010-2014 were identified from the Nationwide Readmissions Database. A propensity score-matched analysis (PSMA) with > 40 covariates including demographics, comorbidities, and hospitalization factors was performed between those receiving cholecystectomy alone versus incidental appendectomy at the time of cholecystectomy. RESULTS: 34,390 patients underwent cholecystectomy (median age 15 [13-17] years). Laparoscopic (92%) approach was utilized most frequently, with 2% requiring conversion to open cholecystectomy. PSMA demonstrated a higher frequency of perforation or laceration of adjacent organs occurring in those receiving cholecystectomy alone during index admission. No significant differences in readmissions within 30 days or the calendar year were detected. Those undergoing cholecystectomy alone had higher overall readmission costs ($11,783 [$4942-$39,836] vs. $6,100 [$2358-$19,719] cholecystectomy with appendectomy; p = 0.010). CONCLUSION: This nationwide PSMA indicates that incidental appendectomy in pediatric cholecystectomies is not associated with higher postoperative complications, cost, or readmissions. This suggests that incidental appendectomy during cholecystectomy is safe, cost-effective, and worthy of future study. LEVEL OF EVIDENCE: Level III.
BACKGROUND: The utility of incidental appendectomy, appendectomy during another index surgery in the absence of appendicitis, has not been evaluated in the pediatric population during cholecystectomy. This study sought to compare nationwide outcomes after cholecystectomy with incidental appendectomy in children. METHODS: Patients ≤ 18 years old who underwent cholecystectomy from 2010-2014 were identified from the Nationwide Readmissions Database. A propensity score-matched analysis (PSMA) with > 40 covariates including demographics, comorbidities, and hospitalization factors was performed between those receiving cholecystectomy alone versus incidental appendectomy at the time of cholecystectomy. RESULTS: 34,390 patients underwent cholecystectomy (median age 15 [13-17] years). Laparoscopic (92%) approach was utilized most frequently, with 2% requiring conversion to open cholecystectomy. PSMA demonstrated a higher frequency of perforation or laceration of adjacent organs occurring in those receiving cholecystectomy alone during index admission. No significant differences in readmissions within 30 days or the calendar year were detected. Those undergoing cholecystectomy alone had higher overall readmission costs ($11,783 [$4942-$39,836] vs. $6,100 [$2358-$19,719] cholecystectomy with appendectomy; p = 0.010). CONCLUSION: This nationwide PSMA indicates that incidental appendectomy in pediatric cholecystectomies is not associated with higher postoperative complications, cost, or readmissions. This suggests that incidental appendectomy during cholecystectomy is safe, cost-effective, and worthy of future study. LEVEL OF EVIDENCE: Level III.
Authors: Afif N Kulaylat; Holden Richards; Keigo Yada; David Coyle; Rita Shelby; Amanda J Onwuka; Jennifer H Aldrink; Karen A Diefenbach; Marc P Michalsky Journal: J Pediatr Surg Date: 2020-11-20 Impact factor: 2.545
Authors: Raaj K Ruparel; James N Bogert; Christopher R Moir; Michael B Ishitani; Shakila P Khan; Vilmarie Rodriguez; Abdalla E Zarroug Journal: J Pediatr Surg Date: 2014-03 Impact factor: 2.545