eMedicineLive

A delay of more than two days in treating a pediatric appendicitis patient after the patient has been admitted to the hospital has been found to be associated with an increase in the incidence of related complications. This is the finding of a new study which was presented yesterday at the American Academy of Pediatrics (AAP) National Conference and Exhibition in Boston.

 

The study, called as "Missed Opportunities in the Treatment of Pediatric Appendicitis," was led by Dr. Justin Lee and analyzed the data from the National Inpatient Sample (NIS) on around 800.000 appendectomies. The children in the study underwent appendectomy 4.5 days after admission to the hospital. They were found to suffer from increased incidence of complications such as perforation and abscess formation; longer hospitalization; increased costs; and even death. Around 22.6% of the children in the study suffered from perforated appendix compared to a rate of 18.9% in children who received treatment earlier. Similarly, the mortality rate after delayed treatment increased from 0.03% to 0.68%, an  increase of almost 20 times. The duration of hospitalization also increased in case of delayed treatment. On an average, children who received a delayed treatment spent more than 10 days in the hospital compared to 2.89 days in other children. In case the children were treated within two days of hospitalization, the expenditure on treatment averaged about $18,000. However, when treatment was delayed, the expenditure jumped to $54,172.

 

The complications associated with delayed treatment led to other procedures. There was 13 times more likelihood of the patient undergoing drainage procedures, six times more chances of cecectomy (removal of cecum) and 14 times increased chances of hemicolectomy (removal of a part of the colon). The researchers in the study also found that children suffering from other co-morbid conditions like leukemia, neutropenia, etc were more likely to receive a delayed treatment. This is because they are likely to have a missed diagnosis. Steps need to be taken to diagnose the condition early, especially in patients suffering from other co-morbid conditions to reduce the incidence of surgical complications and decrease the total expenditure and time spent in the hospital.

 

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