- 作者：Christina Feng ; Seema Anandalwar ; Feroze Sidhwa ; Charity Glass ; Mahima Karki ; David Zurakowski ; Shawn J. Rangel ; Shawn.Rangel@childrens.harvard.edu" class="auth_mail" title="E-mail the corresponding author
- 关键词：Complicated appendicitis ; Peritoneal contamination ; Pediatric appendicitis
- 刊名：Journal of Pediatric Surgery
- 出版年：2016
- 出版时间：November 2016
- 年：2016
- 卷：51
- 期：11
- 页码：1896-1899
- 全文大小：239 K
Methods
Intraoperative findings were collected prospectively at a single children's hospital from 2012 to 2014. The degree of peritoneal contamination was categorized as either “localized” (confined to the right lower quadrant and pelvis) or “extensive” (extending to the liver). Imaging utilization, postoperative length of stay (pLOS), hospital cost, and readmission rates were compared between groups.
Results
Of 88 patients with complicated appendicitis, 38% had extensive contamination. Preoperative characteristics were similar between groups. Patients with extensive contamination had higher rates of postoperative imaging (58.8% vs 27.7%, P < 0.01), a 50% longer median pLOS (6 days [IQR 4–9] vs 4 days [IQR 2–5], P = 0.003), a 30% higher median hospital cost ($17,663 [IQR $12,564–$23,697] vs $13,516 [IQR $10,546–$16,686], P = 0.004), and a nearly four-fold higher readmission rate (20.6% vs 5.6%, P = 0.04) compared to children with localized contamination.
Conclusion
Extensive peritoneal contamination is associated with significantly higher resource utilization compared to localized contamination in children with complicated appendicitis. These findings may have important severity-adjustment implications for reimbursement and readmission rate reporting for hospitals that serve populations where late presentation is common.