Population-Based Intraoperative Disease Severity Criteria for Pediatric Appendicitis

被引:2
作者
McKie, Kerri A. [1 ]
Graham, Donne A. [2 ]
Cramm, Shannon L. [3 ]
Saito, Jacqueline M. [4 ]
Rangel, Shawn J. [1 ]
机构
[1] Harvard Med Sch, Boston Childrens Hosp, Dept Surg, Boston, MA USA
[2] Boston Childrens Hosp, Program Patient Safety & Qual, Boston, MA USA
[3] Harvard Med Sch, Massachusetts Gen Hosp, Dept Surg, Boston, MA USA
[4] Washington Univ St Louis, Div Pediat Surg, St Louis, MO USA
关键词
RESOURCE UTILIZATION; CHILDREN; MANAGEMENT;
D O I
10.1001/jamasurg.2024.1759
中图分类号
R61 [外科手术学];
学科分类号
摘要
Importance A standardized severity assessment approach is needed in children with appendicitis for postoperative adverse event estimation and severity adjustment for hospital-level comparative performance reporting. Objective To examine the association between the presence and number of National Surgical Quality Improvement Program (NSQIP) Pediatric-defined intraoperative criteria for complicated appendicitis and outcomes in a population-based sample of children. Design, Setting, and Participants This cohort study used data from the American College of Surgeons NSQIP Pediatric Appendectomy Procedure Targeted Participant Use Data File and General Participant Use Data File for children younger than 18 years who underwent appendectomy from January 1, 2019, through December 31, 2022, at 148 hospitals participating in NSQIP Pediatric. ExposureThe presence of NSQIP Pediatric intraoperative criteria for complicated appendicitis (ie, visible perforation, intraperitoneal abscess, extraluminal fecalith, and diffuse fibrinopurulent exudate). Main Outcomes and Measures Adverse event outcomes included postoperative rates of any surgical site infection (incisional or organ space), percutaneous drainage, sepsis, and reoperation. Resource use outcomes included operative duration and hospital length of stay, and rates of postoperative imaging, parenteral nutrition use, and revisits. Multivariable regression was used to explore the influence of individual and combinations of intraoperative criteria on outcomes after adjusting for patient characteristics. Results Of 82 950 patients included, 23 221 (27.9%) had at least 1 finding of complicated appendicitis. Compared with cases without any criteria present, the presence of each finding of complicated appendicitis was independently associated with higher rates of any adverse events; adjusted odds ratios (AORs) by finding were 5.57 (95% CI, 5.04-6.15) for visible hole, 4.83 (95% CI, 4.17-5.59) for diffuse fibrinopurulent exudate, 7.06 (95% CI, 5.77-8.63) for abscess, and 6.62 (95% CI, 4.78-9.15) for fecalith. An increasing number of criteria was associated with a stepwise increase in risk of any adverse events; AOR by number of criteria met were 5.55 (95% CI, 5.09-6.05) for 1 criterion, 8.86 (95% CI, 8.16-9.62) for 2 criteria, and 16.65 (95% CI, 15.10-18.35) for >= 3 criteria. Similar patterns in criteria-specific and cumulative implications for outcomes were observed with each individual adverse event and resource use measure. Conclusions and Relevance This cohort study found that postoperative complications and increased resource use are associated with the presence and number of NSQIP Pediatric criteria for complicated appendicitis. These criteria should be considered the gold standard, evidence-based severity assessment framework for estimating risk of adverse events and resource use in children with appendicitis.
引用
收藏
页码:1041 / 1050
页数:10
相关论文
共 15 条
  • [1] American College of Surgeons, 2017, NAT SURG QUAL IMPR P
  • [2] American College of Surgeons, 2023, USER GUIDE 2022 ACS
  • [3] Association of lntraoperative Findings With Outcomes and Resource Use in Children With Complicated Appendicitis
    Anandalwar, Seema P.
    Cameron, Danielle B.
    Graham, Dionne A.
    Melvin, Patrice
    Dunlap, Jonathan L.
    Kashtan, Mark
    Hall, Matthew
    Saito, Jacqueline M.
    Barnhart, Douglas C.
    Kenney, Brian D.
    Rangel, Shawn J.
    [J]. JAMA SURGERY, 2018, 153 (11) : 1021 - 1027
  • [4] Failure in the nonoperative management of pediatric ruptured appendicitis: predictors and consequences
    Aprahamian, Charles J.
    Barnhart, Douglas C.
    Bledsoe, Samuel E.
    Vaid, Yoginder
    Harmon, Carroll M.
    [J]. JOURNAL OF PEDIATRIC SURGERY, 2007, 42 (06) : 934 - 938
  • [5] Development and Implications of an Evidence-based and Public Health-relevant Definition of Complicated Appendicitis in Children
    Cameron, Danielle B.
    Anandalwar, Seema P.
    Graham, Dionne A.
    Melvin, Patrice
    Serres, Stephanie K.
    Dunlap, Jonathan L.
    Kashtan, Mark
    Hall, Matthew
    Saito, Jacqueline M.
    Barnhart, Douglas C.
    Kenney, Brian D.
    Rangel, Shawn J.
    [J]. ANNALS OF SURGERY, 2020, 271 (05) : 962 - 968
  • [6] Quantifying the Burden of Interhospital Cost Variation in Pediatric Surgery Implications for the Prioritization of Comparative Effectiveness Research
    Cameron, Danielle B.
    Graham, Dionne A.
    Milliren, Carly E.
    Glass, Charity C.
    Feng, Christina
    Sidhwa, Feroze
    Thangarajah, Hariharan
    Hall, Matthew
    Rangel, Shawn J.
    [J]. JAMA PEDIATRICS, 2017, 171 (02)
  • [7] Determinants of postoperative abscess occurrence and percutaneous drainage in children with perforated appendicitis
    Emil, Sherif
    Elkady, Sherif
    Shbat, Layla
    Youssef, Fouad
    Baird, Robert
    Laberge, Jean-Martin
    Puligandla, Pramod
    Shaw, Kenneth
    [J]. PEDIATRIC SURGERY INTERNATIONAL, 2014, 30 (12) : 1265 - 1271
  • [8] Operative Findings Are a Better Predictor of Resource Utilization in Pediatric Appendicitis
    Farach, Sandra M.
    Danielson, Paul D.
    Walford, N. Elizabeth
    Harmel, Richard P., Jr.
    Chandler, Nicole M.
    [J]. JOURNAL OF PEDIATRIC SURGERY, 2015, 50 (09) : 1574 - 1578
  • [9] Beyond perforation: Influence of peritoneal contamination on clinical severity and resource utilization in children with perforated appendicitis
    Feng, Christina
    Anandalwar, Seema
    Sidhwa, Feroze
    Glass, Charity
    Karki, Mahima
    Zurakowski, David
    Rangel, Shawn J.
    [J]. JOURNAL OF PEDIATRIC SURGERY, 2016, 51 (11) : 1896 - 1899
  • [10] Acute appendicitis: A disease severity score for the acute care surgeon
    Garst, Geoffrey C.
    Moore, Ernest E.
    Banerjee, Monisha N.
    Leopold, David K.
    Burlew, Clay Cothren
    Bensard, Denis D.
    Biffl, Walter L.
    Barnett, Carlton C.
    Johnson, Jeffrey L.
    Sauaia, Angela
    [J]. JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 2013, 74 (01) : 32 - 36