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