Pediatric, General Surgeons Share Appendectomy Outcomes

Clinical outcomes in pediatric appendectomies performed by pediatric surgeons and general surgeons do not differ significantly, reported Dr. Sherif Emil and Michael Taylor.

“There are no specialty-dependent differences in clinical outcomes for simple or complicated appendicitis,” they said. However, simple appendicitis treated by pediatric surgeons was associated with lower hospital costs (J. Am. Coll. Surg. 2007;204:34–9).

To determine whether specialty-dependent differences exist, Dr. Emil and Mr. Taylor of the University of California, Irvine, evaluated clinical characteristics and surgical outcomes of children treated for appendicitis at Miller Children's Hospital in Long Beach, Calif.

The study was based on a review of the medical charts of 465 patients under age 18 who were treated between January 2002 and May 2004.

During the study period, the hospital staff included 26 general surgeons credentialed to perform open appendectomy in patients at least 6 years old.

Of these, 24 surgeons were also credentialed to perform laparoscopic appendectomy in that patient population. Only three general surgeons were credentialed to perform open appendectomy in patients younger than 6 years, and only one was credentialed to perform laparoscopic appendectomy in patients younger than 6 years old.

The pediatric surgical staff consisted of three fellowship-trained, board-certified pediatric surgeons credentialed to perform both open and laparoscopic appendectomy in patients up to age 21 years.

Two of the pediatric surgeons in the study were in academic practice. The third pediatric surgeon and all 26 of the general surgeons were in private practice.

Rates of misdiagnosis, postoperative readmission, wound infection, intra-abdominal infection, and duration of hospital stay were assessed as primary outcomes.

Hospital charges were assessed as a secondary outcome.

The pediatric surgeons treated two-thirds of the children (304), including all but 1 of the 75 children younger than 6 years.

These 304 cases were distributed equally among the three pediatric surgeons, each of whom performed 50–60 appendectomies annually during the 2-year study period.

Of the 26 general surgeons, only 1 performed more than 10 pediatric appendectomies per year during the study period, and only 4 performed more than 5 per year.

Among the general surgeons, the median number of pediatric appendectomies performed per year was 1 (range, 0–11).

Patients in both groups had similar demographic and clinical characteristics, with a few significant differences.

Pediatric surgeons treated children whose mean age was 8.3 years, vs. 13.2 years for those treated by general surgeons.

Pediatric surgeons also treated a significantly higher percentage of children transferred from other hospitals than did general surgeons (42% vs. 23%) and a higher percentage of patients with complicated appendicitis (54% vs. 33%).

Misdiagnosis rates were 4.3% in the pediatric surgeons' group and 5.6% in the general surgeons' group.

For treatment of simple appendicitis, mean hospital stay was 1.82 days in the pediatric surgeons' group, vs. 1.94 days in the general surgeons' group.

Readmission rates were higher in the general surgeons' group than in the pediatric surgeons' group, both for simple appendicitis (2% vs. 0%, respectively) and for complicated appendicitis (6% vs. 2%, respectively).

Complicated appendicitis was associated with higher wound infection and intra-abdominal infection rates in the general surgeons' group (2% and 4%, respectively) than in the pediatric surgeons' group (0.6% and 1%, respectively), but the differences did not reach statistical significance.

Mean hospital stays for complicated appendicitis were 5.21 days in the pediatric surgeons' group and 4.68 days in the general surgeons' group.

General surgeons used postoperative antibiotics in a significantly higher percentage of simple appendicitis cases than did pediatric surgeons (77% vs. 55%, respectively).

Similarly, general surgeons prescribed oral antibiotics on discharge to a higher percentage of patients than did pediatric surgeons, following in-hospital treatment of simple appendicitis (15% vs. 4%, respectively) or complicated appendicitis (66% vs. 30%, respectively).

Median hospital charges for simple appendicitis were $10,735 for the pediatric surgeons' group vs. $11,613 for the general surgeons' group.

A subset analysis of patients aged 6 years and older showed a trend toward shorter hospital stays in the pediatric surgeons' group than in the general surgeons' group (1.75 days vs. 1.94 days, respectively).

Shorter hospital stays and lower use of antibiotics could account for the lower hospital costs for simple appendicitis treated by pediatric surgeons, the authors said.

Clinical outcomes in pediatric appendectomies performed by pediatric surgeons and general surgeons do not differ significantly, reported Dr. Sherif Emil and Michael Taylor.

“There are no specialty-dependent differences in clinical outcomes for simple or complicated appendicitis,” they said. However, simple appendicitis treated by pediatric surgeons was associated with lower hospital costs (J. Am. Coll. Surg. 2007;204:34–9).

To determine whether specialty-dependent differences exist, Dr. Emil and Mr. Taylor of the University of California, Irvine, evaluated clinical characteristics and surgical outcomes of children treated for appendicitis at Miller Children's Hospital in Long Beach, Calif.

The study was based on a review of the medical charts of 465 patients under age 18 who were treated between January 2002 and May 2004.

During the study period, the hospital staff included 26 general surgeons credentialed to perform open appendectomy in patients at least 6 years old.

Of these, 24 surgeons were also credentialed to perform laparoscopic appendectomy in that patient population. Only three general surgeons were credentialed to perform open appendectomy in patients younger than 6 years, and only one was credentialed to perform laparoscopic appendectomy in patients younger than 6 years old.

The pediatric surgical staff consisted of three fellowship-trained, board-certified pediatric surgeons credentialed to perform both open and laparoscopic appendectomy in patients up to age 21 years.

Two of the pediatric surgeons in the study were in academic practice. The third pediatric surgeon and all 26 of the general surgeons were in private practice.

Rates of misdiagnosis, postoperative readmission, wound infection, intra-abdominal infection, and duration of hospital stay were assessed as primary outcomes.

Hospital charges were assessed as a secondary outcome.

The pediatric surgeons treated two-thirds of the children (304), including all but 1 of the 75 children younger than 6 years.

These 304 cases were distributed equally among the three pediatric surgeons, each of whom performed 50–60 appendectomies annually during the 2-year study period.

Of the 26 general surgeons, only 1 performed more than 10 pediatric appendectomies per year during the study period, and only 4 performed more than 5 per year.

Among the general surgeons, the median number of pediatric appendectomies performed per year was 1 (range, 0–11).

Patients in both groups had similar demographic and clinical characteristics, with a few significant differences.

Pediatric surgeons treated children whose mean age was 8.3 years, vs. 13.2 years for those treated by general surgeons.

Pediatric surgeons also treated a significantly higher percentage of children transferred from other hospitals than did general surgeons (42% vs. 23%) and a higher percentage of patients with complicated appendicitis (54% vs. 33%).

Misdiagnosis rates were 4.3% in the pediatric surgeons' group and 5.6% in the general surgeons' group.

For treatment of simple appendicitis, mean hospital stay was 1.82 days in the pediatric surgeons' group, vs. 1.94 days in the general surgeons' group.

Readmission rates were higher in the general surgeons' group than in the pediatric surgeons' group, both for simple appendicitis (2% vs. 0%, respectively) and for complicated appendicitis (6% vs. 2%, respectively).

Complicated appendicitis was associated with higher wound infection and intra-abdominal infection rates in the general surgeons' group (2% and 4%, respectively) than in the pediatric surgeons' group (0.6% and 1%, respectively), but the differences did not reach statistical significance.

Mean hospital stays for complicated appendicitis were 5.21 days in the pediatric surgeons' group and 4.68 days in the general surgeons' group.

General surgeons used postoperative antibiotics in a significantly higher percentage of simple appendicitis cases than did pediatric surgeons (77% vs. 55%, respectively).

Similarly, general surgeons prescribed oral antibiotics on discharge to a higher percentage of patients than did pediatric surgeons, following in-hospital treatment of simple appendicitis (15% vs. 4%, respectively) or complicated appendicitis (66% vs. 30%, respectively).

Median hospital charges for simple appendicitis were $10,735 for the pediatric surgeons' group vs. $11,613 for the general surgeons' group.

A subset analysis of patients aged 6 years and older showed a trend toward shorter hospital stays in the pediatric surgeons' group than in the general surgeons' group (1.75 days vs. 1.94 days, respectively).

Shorter hospital stays and lower use of antibiotics could account for the lower hospital costs for simple appendicitis treated by pediatric surgeons, the authors said.

Clinical outcomes in pediatric appendectomies performed by pediatric surgeons and general surgeons do not differ significantly, reported Dr. Sherif Emil and Michael Taylor.

“There are no specialty-dependent differences in clinical outcomes for simple or complicated appendicitis,” they said. However, simple appendicitis treated by pediatric surgeons was associated with lower hospital costs (J. Am. Coll. Surg. 2007;204:34–9).

To determine whether specialty-dependent differences exist, Dr. Emil and Mr. Taylor of the University of California, Irvine, evaluated clinical characteristics and surgical outcomes of children treated for appendicitis at Miller Children's Hospital in Long Beach, Calif.

The study was based on a review of the medical charts of 465 patients under age 18 who were treated between January 2002 and May 2004.

During the study period, the hospital staff included 26 general surgeons credentialed to perform open appendectomy in patients at least 6 years old.

Of these, 24 surgeons were also credentialed to perform laparoscopic appendectomy in that patient population. Only three general surgeons were credentialed to perform open appendectomy in patients younger than 6 years, and only one was credentialed to perform laparoscopic appendectomy in patients younger than 6 years old.

The pediatric surgical staff consisted of three fellowship-trained, board-certified pediatric surgeons credentialed to perform both open and laparoscopic appendectomy in patients up to age 21 years.

Two of the pediatric surgeons in the study were in academic practice. The third pediatric surgeon and all 26 of the general surgeons were in private practice.

Rates of misdiagnosis, postoperative readmission, wound infection, intra-abdominal infection, and duration of hospital stay were assessed as primary outcomes.

Hospital charges were assessed as a secondary outcome.

The pediatric surgeons treated two-thirds of the children (304), including all but 1 of the 75 children younger than 6 years.

These 304 cases were distributed equally among the three pediatric surgeons, each of whom performed 50–60 appendectomies annually during the 2-year study period.

Of the 26 general surgeons, only 1 performed more than 10 pediatric appendectomies per year during the study period, and only 4 performed more than 5 per year.

Among the general surgeons, the median number of pediatric appendectomies performed per year was 1 (range, 0–11).

Patients in both groups had similar demographic and clinical characteristics, with a few significant differences.

Pediatric surgeons treated children whose mean age was 8.3 years, vs. 13.2 years for those treated by general surgeons.

Pediatric surgeons also treated a significantly higher percentage of children transferred from other hospitals than did general surgeons (42% vs. 23%) and a higher percentage of patients with complicated appendicitis (54% vs. 33%).

Misdiagnosis rates were 4.3% in the pediatric surgeons' group and 5.6% in the general surgeons' group.

For treatment of simple appendicitis, mean hospital stay was 1.82 days in the pediatric surgeons' group, vs. 1.94 days in the general surgeons' group.

Readmission rates were higher in the general surgeons' group than in the pediatric surgeons' group, both for simple appendicitis (2% vs. 0%, respectively) and for complicated appendicitis (6% vs. 2%, respectively).

Complicated appendicitis was associated with higher wound infection and intra-abdominal infection rates in the general surgeons' group (2% and 4%, respectively) than in the pediatric surgeons' group (0.6% and 1%, respectively), but the differences did not reach statistical significance.

Mean hospital stays for complicated appendicitis were 5.21 days in the pediatric surgeons' group and 4.68 days in the general surgeons' group.

General surgeons used postoperative antibiotics in a significantly higher percentage of simple appendicitis cases than did pediatric surgeons (77% vs. 55%, respectively).

Similarly, general surgeons prescribed oral antibiotics on discharge to a higher percentage of patients than did pediatric surgeons, following in-hospital treatment of simple appendicitis (15% vs. 4%, respectively) or complicated appendicitis (66% vs. 30%, respectively).

Median hospital charges for simple appendicitis were $10,735 for the pediatric surgeons' group vs. $11,613 for the general surgeons' group.

A subset analysis of patients aged 6 years and older showed a trend toward shorter hospital stays in the pediatric surgeons' group than in the general surgeons' group (1.75 days vs. 1.94 days, respectively).

Shorter hospital stays and lower use of antibiotics could account for the lower hospital costs for simple appendicitis treated by pediatric surgeons, the authors said.