Minimizing unnecessary parenteral nutrition after appendectomy in children

Background: Consensus guidelines have indicated that postoperative parenteral nutrition (PN) might provide benefit when patients are expected to be nil per os (NPO) >= 7 d and when PN is administered >= 5 d. We hypothesized that most children receiving PN after appendectomy do not satisfy these criteria. Methods: The medical records of the patients who had undergone appendectomy for perforated appendicitis from 2006-2011 were analyzed, and the proportion meeting the criteria for beneficial PN was determined. The clinical parameters independently associated with the criteria for beneficial PN (PN therapy >= 5 d, ileus >= 5 d, NPO >= 7 d) were identified using multiple regression analysis. Results: A total of 1612 patients were treated for appendicitis. Of these, 587 met the inclusion criteria (age <16 y, perforated appendicitis, appendectomy within 24 h, no previous indication for PN). Of the 587 patients, 12.1% received PN; 43.8% of these received PN for >= 5 d. The predictors of PN duration of >= 5 d included preoperative symptoms for >= 3 d (P < 0.01) and initiation of PN by postoperative day 3 (P = 0.047). Preoperative symptoms for >= 3 d, imaging showing a discrete abscess or bowel obstruction, and operative findings of diffuse peritonitis predicted ileus of >= 5 d and NPO of >= 7 d (P < 0.01 for all). Major complications were more common in patients with ileus lasting >= 5 d. Conclusions: Fewer than one-half of patients receiving PN in the present cohort met the consensus-based guidelines for postoperative PN. The preoperative symptom duration, preoperative imaging findings demonstrating abscess and/or bowel obstruction, and intraoperative findings of diffuse peritonitis might predict prolonged ileus and longer recovery periods for children undergoing surgery for perforated appendicitis. (C) 2013 Elsevier Inc. All rights reserved.