Risk factors associated with advanced appendicitis and complications after childhood appendectomy

Abstract

Background: In children treated for suspected acute appendicitis, limited information is available about the relation between delay in presentation or treatment, disease severity, or complications. Methods: A retrospective observational study was done in 435 children (<15 years) who had surgery for a preoperative diagnosis of appendicitis during a 14 year period in a rural hospital. Data included time from onset of symptoms to surgery, presence of advanced appendicitis (gangrene, perforation, abscess or mass of the appendix, or peritonitis), and postoperative complications within 1 year after surgery. Results: Of the 435 patients who had surgery, non-advanced appendicitis was noted in 285 (66%) patients, advanced appendicitis in 67 (15%) patients, and no appendicitis in 83 (19%) patients. The mean time from onset of symptoms to beginning of surgery was 33 (plus or minus) 22 h. Postoperative complications occurred in 25 (6%) patients. Advanced appendicitis was significantly associated with the time from onset of symptoms to arrival at the emergency department; time from onset of symptoms to beginning of surgery; use of antibiotics before surgery; age of the patient; and preoperative rebound tenderness, fever, tachycardia, tachypnea, leukocytosis, and Alvarado score e 5. Postoperative complications in all patients were significantly associated with preoperative fever, tachypnea, and advanced appendicitis. Conclusions: For children with appendicitis, delays in surgery may be associated with increased frequency of advanced appendicitis. Preoperative fever or tachypnea may be associated with postoperative complications and may indicate that priority be advised for urgent surgery in patients with these signs.