A Call for a Standardized Definition of Perforated Appendicitis

Overview

Journal J Pediatr Surg

Specialties General Surgery
Pediatrics

Date 2016 Nov 26

PMID 27884453

Citations 5

Authors

Andrew P Rogers

Tiffany J Zens

Charles M Leys

Peter F Nichol

Daniel J Ostlie

Affiliations

Soon will be listed here.

Abstract

Background: Abscess rates have been reported to be as low as 1% and as high as 50% following perforated appendicitis (PA). This range may be because of lack of universal definition for PA. An evidence-based definition (EBD) is crucial for accurate wound classification, risk-stratification, and subsequent process optimization. ACS NSQIP-Pediatric guidelines do not specify a definition of PA. We hypothesize that reported postoperative abscess rates underrepresent true incidence, as they may include low-risk cases in final calculations.

Methods: Local institutional records of PA patients were reviewed to calculate the postoperative abscess rate. The ACS NSQIP-Pediatric participant use file (PUF) was used to determine cross-institutional postoperative abscess rates. A PubMed literature review was performed to identify trials reporting PA abscess rates, and definitions and rates were recorded.

Results: 20.9% of our patients with PA developed a postoperative abscess. The ACS NSQIP-Pediatric abscess rate was significantly lower (7.61%, p<0.001). In the eighteen published studies analyzed, average abscess rate (14.49%) was significantly higher than ACS NSQIP-Pediatric (p<0.001). There was significantly more variation in trials that do not employ an EBD of perforation (Levene's test F-value =6.980, p=0.018).

Conclusions: A standard EBD of perforation leads to lower variability in reported postoperative abscess rates following PA. Nonstandard definitions may be significantly altering the aggregate rate of postoperative abscess formation. We advocate for adoption of a standard definition by all institutions participating in ACS NSQIP-Pediatric data submission.

Level Of Evidence: III.

Citing Articles

Effect of peritoneal and wound lavage with super-oxidized solution on surgical-site infection after open appendicectomy in perforated appendicitis (PLaSSo): randomized clinical trial.

Sellappan H, Alagoo D, Loo C, Vijian K, Sibin R, Chuah J BJS Open. 2024; 8(5).

PMID: 39413050 PMC: 11482247. DOI: 10.1093/bjsopen/zrae121.

Distilling the Key Elements of Pediatric Appendicitis Clinical Practice Guidelines.

Ingram M, Harris C, Studer A, Martin S, Berman L, Alder A J Surg Res. 2020; 258:105-112.

PMID: 33010554 PMC: 7736270. DOI: 10.1016/j.jss.2020.08.056.

Management of appendiceal mass and abscess in children; early appendectomy or initial non-operative treatment? A systematic review and meta-analysis.

van Amstel P, Sluckin T, van Amstel T, van der Lee J, de Vries R, Derikx J Surg Endosc. 2020; 34(12):5234-5249.

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Surgeon's Definition of Complicated Appendicitis: A Prospective Video Survey Study.

Mariage M, Sabbagh C, Grelpois G, Prevot F, Darmon I, Regimbeau J Euroasian J Hepatogastroenterol. 2020; 9(1):1-4.

PMID: 31988858 PMC: 6969325. DOI: 10.5005/jp-journals-10018-1286.

Implementing a surgeon-reported categorization of pediatric appendicitis severity.

Baxter K, Short H, Travers C, Heiss K, Raval M Pediatr Surg Int. 2018; 34(12):1281-1286.

PMID: 30317376 DOI: 10.1007/s00383-018-4364-8.

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