Back to Annual Meeting Program

Background: This study sought to evaluate the effect of in-hospital delay and determine associated co-morbidities in the delayed treatment of pediatric acute appendicitis.
Methods: This was a retrospective analysis of the National Inpatient Sample from 2000 to 2008. Immediate treatment was defined as treatment in hospital day 0 or 1. Delay in treatment was defined as treatment in hospital day 2 and beyond.
Results: During the study period, 683,016 pediatric appendicitis were identified. 17,737 (2.6%) experienced a delay in treatment, 4.44 (SEM, 0.05) days. Multivariate analysis identified predictive co-morbidities for delay in treatment: ALL (OR 12.84, CI 11.04-14.94), AML (OR 9.41, CI 7.58-11.68), neutropenia (OR 5.53, CI 4.60-6.65), and ovarian cyst without torsion (OR 3.17, CI 2.94-3.42). Surgical management included more than 13-fold increase in drainage procedures (5.5% vs 0.4%), six-fold increase in cecectomy (1.2% vs 0.2%), 14-fold increase in hemicolectomy (1.4% vs 0.1%), 11-fold increase in small bowel laceration suture repair (1.1% vs 0.1%), and 15-fold increase in small bowel resection (1.5% vs 0.1%).
Conclusion: In-hospital delay beyond 2 days has a significant negative impact on patients with acute appendicitis with regard to complications, economic burden, and subsequent surgical management. Using the co-morbidity index, high-risk co-morbidities with associated delay in treatment were identified.