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eMedicineLive - Early Appendectomy for Perforated Appendix Improves Outcome for Children

Early Appendectomy for Perforated Appendix Improves Outcome for Children


Every year around 77,000 children in the U.S. are admitted into hospitals because of appendicitis. Almost one third of them, especially those below the age of four are more likely to develop a perforation of the appendix before they are operated. However, research has shown that performing an appendectomy in children with perforated appendix as early as possible can reduce the total health care expenditure incurred because of the condition. The research, which has been published in the latest issue of the Journal of the American College of Surgeons, was led by Dr. Martin L. Blakely, an associate professor of surgery and pediatrics at Vanderbilt University School of Medicine, Nashville, Tenn.
For their study, the researchers considered 131 pediatric patients admitted at LeBonheur Children’s Hospital, Memphis, Tenn., with perforated appendicitis. The children were randomly divided into two groups: the first group underwent appendectomy as soon as the diagnosis of perforated appendix was made; the second group underwent appendectomy eight weeks after the diagnosis. Data was collected about resource usage and cost, labor cost, facility services, supplies and patient support services. Data pertaining to expenditure incurred in managing medical records, hospital admissions, and billing procedures, were also analyzed for each participant.
It was observed that the hospital stay of children who underwent appendectomy after a waiting period was longer by two days, compared to children who underwent the operation almost immediately. While 44% of the children with an early operation required a central venous catheter, this figure rose to 87% in children with delayed operation. 43% of the patients with a late operation were discharged along with the central venous catheter compared to just 9%of the children who underwent an early operation. A delayed operation often led to side effects like an intra-abdominal abscess or an intestinal blockage, which in turn led to an extended stay in the hospital and increased expenditure. 55% of patients with delayed operation developed these complications, compared to 30% in case of an early operation.