Length of preorepative hospital stay increases risk of negative appendectomy in children

Abstract

Background: As per the nationwide treatment guidelines, it is imperative to rule out or diagnose acute appendicitis no later than six hours following hospital admission. An unusual clinical presentation could mislead the surgeon, delaying the appendectomy or causing them to miss another condition. Numerous investigations have demonstrated no significant differences in perforation rates between patients operated on 12 and 24 hours following admission. On the other hand, not enough information is available on the risk of negative appendectomies in children. Aim: The aim of this research was to investigate the potential impact of a prolonged post-hospital stay (PHS) on the negative appendectomy rate (NAR) in pediatric patients. Additionally, we sought to examine concurrent pathology that delays appendectomy and prevents prompt detection of appendicitis. Materials and procedures: During the course of a year, we enrolled 55 instances of pediatric atypical appendicitis in this retrospective analysis. The following general inclusion criteria were used: preoperative hospital stay (PHS) of more than six hours, in excess of the recommended national treatment procedure, and subsequent surgery (appendectomy). Due to peculiarities in clinical course, patients younger than five were not eligible for further research (n = 7). Additionally, the patients were divided into two groups: group I (PHS between 6 to 12 hours; n = 36) and group II (PHS > 12 hours; n = 12) Results: 1) In group I, there was a single case (2.7%) with a normal appendix. The pathology report states that one patient experienced appendicitis for a total of thirteen hours, which is similar to superficial catarrhal inflammation. In group II, three patients (or 25%) had normal appendices (p = 0.0406). 2) Patients with PHS > 12 hours had an odds ratio that is 12 times higher than those with PHS > 6 - ≤ 12 hours. (OR=12; p=0.0406; 95% CI [1.11 – 129.42]). 3) In group I, concomitant diseases included, enterobiasis (2.7 %; 1/36), ketonuria (+4) (8.3 %; 3/36), ketonuria (+4) (16.6 %; 2/12) (p=0.5872), ascariasis (8.3 %; 1/12) (p=0.4415), and Alport syndrome (2.7%; 1/36). In group II, concomitant diseases included mesenteric adenitis (16.6 %; 2/12) (p=0.1501), ascariasis (8.3 %; 1/12) (p= 0.4415). 4) There was no difference in WBC levels between group I, which was 11.1±3.5*109, and group II, which was 10.9±4.96*109 (p=0,8807). 5) Overall, only 39.5% of patients had an abdominal ultrasound performed, and the results showed that 54% and 50% of patients in groups I and II, respectively, had appendicitis (p=1.000). Conclusion: The probability of a negative appendectomy is twelve times higher for pediatric patients with PHS lasting longer than twelve hours. Ketonuria and mesenteric adenitis are common diseases linked to prolonged PHS.