PEDIATRIC APPENDECTOMY

Purpose: To define patterns of care and outcome for pediatric appendec tomy. Methods: A study was designed to evaluate all pediatric appendec tomies performed in the 147 Department of Defense hospitals worldwide. Cases of nonincidental appendectomy were identified through discharge diagnoses and operative logs, and 98.6% of the charts were retrieved for review. AII charts were abstracted, and data were entered into a 1 27-field database for analysis. Results: Over a 12-month period, endin g January 1993, appendectomy was performed on 1,366 pediatric patients in the Department of Defense hospital system. The patients' median ag e was 12 years (range, 6 months to 18 years); 59% were mate. The diagn osis was normal appendix for 157 patients (12%), acute nonperforated a ppendicitis for 930 (68%), and perforated appendicitis for 279 (20%). Age less than or equal to 8 years was predictive (P < .001) of a highe r rate of perforated appendicitis (33% v 18%) but was not predictive o f normal pathology (13% v 11%). Female gender was associated with a si gnificantly higher rate of normal pathology (17% v 8%; P < .001) but n ot of perforation (18% v 22%). Temperature elevation and right lower q uadrant pain and tenderness did not clinically distinguish between dia gnostic groups. Sixty-two percent of patients with a normal appendix h ad a white blood cell count of more than 10,000/mm(3), as did 91% of p atients with acute or perforated appendicitis. Those with perforated a ppendicitis received pre- and postoperative antibiotics, primarily amp icillin/gentamicin/clindamycin or Flagyl (41%), cefoxitin (34%), or Un asyn (15%). In 77% of this subgroup, intraoperative cultures were posi tive, with isolates for Escherichia coli (76%) Enterococcus (30%), Bac teroides (24%), and Pseudomonas (20%) predominating. There were no dea ths. Major complications occurred in 1.2% of patients with acute appen dicitis and in 6.4% of those with perforated appendicitis; there were no major complications in the group with normal appendectomies. The ho spitalization period was more than 7 days for 1.6%, 40%, and 3.8%, res pectively. Conclusion: This large series, from a large number of hospi tals, with multiple practitioners, can serve as a community standard f or pediatric appendectomy in the 1990s. Copyright (C) 1995 by W.B. Sau nders Company