Paediatric Appendicitis – Where to Manage It?

ROYAL AUSTRALASIAN COLLEGE OF SURGEONS MEDIA RELEASE

Paediatric Appendicitis – Where to Manage It?

Tuesday 7 May, 2013

The mandatory transfer of paediatric patients with appendicitis to dedicated paediatric surgical units does not appear to be justified by analysis of patient outcomes in a regional centre, delegates to the 82nd Annual Scientific Congress (ASC) of the Royal Australasian College of Surgeons have been told.

Dr Hasitha Balasuriya, a Surgical Resident at Gosford Hospital on the central coast of New South Wales, said there was currently much controversy about whether paediatric appendicitis should be exclusively managed in dedicated paediatric surgical units.

“The cost and possible morbidity associated with mandatory transfer, as well as the inevitable burden on these centres, needs to be formally reviewed against patient outcomes,” Dr Balasuriya said. “This study compares the outcomes of adult and paediatric appendicitis managed by adult focused general surgeons, in a major rural hospital.”

“Data was collected over a fifteen month period across two hospitals in New South Wales. Medical records, operation reports and histopathology reports were collected retrospectively for all appendicectomies. Parameters studied included perioperative complications, laparoscopic to open conversion rates, procedure duration, post-operative stay, readmission rates, and deaths.

“A total of 255 adult and 110 paediatric appendicectomies were reviewed. A greater conversion rate from laparoscopic to open procedure was noted in adults (12.4%) when compared with the paediatric population (4.5%), with a similar complication rate between the two groups. Twenty-two adults (8.6%) and 10 paediatric patients (9.1%) experienced complications, including wound dehiscence, abscess formation, small bowel obstruction, pulmonary embolism and wound infection.

“The mean postoperative stay for adults was 3.26 days while in paediatric patients it was 2.83 days.”

Dr Balasuriya concluded that postoperative outcomes are similar between adult and paediatric patients and that paediatric appendicitis outcomes in this rural centre are comparable to published data.

“This calls into question the need for the mandatory transfer of paediatric patients with appendicitis to dedicated paediatric surgical units,” he said.

Approximately 1200 surgeons from New Zealand, Australia and around the world are attending the ASC, which runs from 6 to 10 May and is being held at Auckland’s Skycity/Crowne Plaza Convention Centre.

ENDS

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