The association of elevated percent bands on admission with failure and complications of interval appendectomy

Background/Purpose: The routine use of interval appendectomy for the treatm ent of perforated appendicitis, with or without abscess, remains controvers ial. The purpose of this study is to confirm the efficacy of this approach and to identify factors associated with failures and complications. Methods: All patients (n = 101) with their clinical diagnosis of perforated appendicitis confirmed with imaging were treated prospectively with fluids and intravenous antibiotics (clindamycin, ceftazidime) and were discharged home on oral fluids and analgesics regardless of fever, Intravenous antibi otics were continued at home until the patients were afebrile for 48 hours, and their white blood cell and differential counts were normal. Patients w ere readmitted at 8 to 12 weeks for an interval appendectomy. Failure to im prove by 72 hours of antibiotic therapy mandated an early appendectomy. P v alues were determined by chi (2) analysis and Student's t test. Results: The 79 patients (78%) successfully treated with interval appendect omy had an overall 6.3% complication rate, and total hospitalization averag ed 5.2 days. The treatment in 21 of 22 patients (22%) requiring early appen dectomy failed because of a clinical picture suggesting small bowel obstruc tion. The patients with the failed procedures had a complication rate of 50 % and were hospitalized an average of 12,8 days. The overall complication r ate for the 101 patients was 15.8%, and the overall total hospitalization w as 6.9 days. Patients requiring early appendectomy had a more frequent find ing resembling a small bowel obstruction on their initial x-ray (50% v 13%, P = .004) and a higher percent band count on their initial differential bl ood cell count (22.6% v 7.6%, P < 0.0001) than did those successfully treat ed with interval appendectomy. An initial band count < 15% was predictive o f an uncomplicated course (84% positive predictive value). Conclusions: Interval appendectomy without complications is successful in t he majority of patients with perforated appendicitis. An elevated initial b and count 15% is associated with an increased likelihood of failure and com plications, J Pediatr Surg 36:165-168. Copyright (C) 2001 by W.B. Saunders Company.