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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2013, Vol. 7 Issue (2) : 264-269     DOI: 10.1007/s11684-013-0259-1
RESEARCH ARTICLE |
Appendiceal inflammation affects the length of stay following appendicectomy amongst children: a myth or reality?
Khurram Siddique1(), Shirin Mirza2, Gandra Harinath1
1. Department of General Surgery, East Kent Hospitals University NHS Foundation Trust, Kent CT1 3NG, United Kingdom; 2. Public Health Solutions (Research & Development Organization), Islamabad 44000, Pakistan
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Abstract  

The effect of the severity of appendiceal inflammation on post-operative stay in children following appendicectomy has shown conflicting results. This study was conducted to determine the association between the severity of appendiceal inflammation and post-operative stay amongst children undergoing open appendicectomy. A retrospective cohort study was conducted at a District General Hospital for two years. A total of 204 patients were included in the study with an age range between 3 and 16 years. Females were 54.9% while the rest were male. Mean age was 12.5±3 years. The association of the severity of appendiceal inflammation and post-operative stay was assessed by multivariable Cox Proportional hazards model. Mean post-operative stay was 2.32 days (95% CI 2.14–2.51). Macroscopically perforated appendix, histological inflammation and post-operative complications were significantly associated with post-operative stay on univariable analysis (P<0.05). Whereas, the multivariable analysis showed that the post-operative stay was significantly prolonged only in case of either perforated appendix or post-operative complications while it remained unaffected by the histological inflammation.

Keywords appendiceal inflammation      post-operative stay      paediatrics     
Corresponding Authors: Siddique Khurram,Email:sk.sid@hotmail.co.uk   
Issue Date: 05 June 2013
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-013-0259-1     OR     http://academic.hep.com.cn/fmd/EN/Y2013/V7/I2/264
Fig.1  Flow diagram of the study.
Post-operative complicationNormal appendix (n = 37)Acute suppurative appendicitis (n = 135)Perforated appendix (n = 32)P valuea
Wound infection: n (% age)0 (0)5 (3.7)11 (34.4)&lt;0.001
Pelvic collection: n (% age)0(0)1 (0.7)3(9.3)0.02
Intestinal obstruction: n (% age)0(0)0(0)3(9.3)0.004
Tab.1  Post-operative complications
VariableMean post-operative stay in days (95% CIa)P value b
Age3 - 11.5 years&gt;11.5 years2.5(2.14 - 2.8)2.2 (2.03 - 2.4)0.12
GenderFemaleMale2.3 (2.1 - 2.5)2.3 (2.05 - 2.6)0.9
Inflammation of appendix at H/PNo inflammationAcute suppurativeGangrenous1.9 (1.6 - 2.1)2.4 (2.2 - 2.6)2.6 (1.6 - 3.6)0.04
Perforated appendixNoYes2.2 (2.0 - 2.3)3 (2.4 - 3.6)0.004
Appendicular abscessNoYes2.2 (2.0 - 2.4)2.6 (2.1 - 3.2)0.07
Symptom duration0 - 1 days2 days≥3 days2.2 (2.01 - 2.4)2.2 (1.7 - 2.6)2.6 (2.2 - 3.0)0.257
Post-operative complicationsNoYes2.1 (1.9 - 2.2)3.1 (2.6 - 3.6)&lt;0.001
Tab.2  Univariable analysis
Fig.2  (A) The association of post-operative stay with appendiceal inflammation at histology. (B) The association of post-operative stay with perforated appendix. (C) The association of post-operative stay with post-operative complications. (D) The association of post-operative stay with appendicular abscess.
VariableTime ratio95% Confidence interval
Age3 - 11.5 years (reference)&gt;11.5 years10.88-0.64 - 1.22
GenderFemale (reference)Male10.83-0.61 - 1.14
Inflammation of appendix at H/PNo inflammationAcute suppurativeGangrenous11.390.89-0.96 - 2.030.34 - 2.3
Perforated appendixNo(reference)Yes11.7-1.07 - 2.69a
Appendicular abscessNoYes11.01-0.67 - 1.53
Symptom duration0 - 1 days (reference)2 days≥3 days10.810.98-0.54 - 1.220.67 - 1.42
Post-operative complicationsNoYes12.26-1.54 - 3.32a
Tab.3  Multivariable analysis by Cox PH model
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