Does age affect the outcomes and management of pediatric appendicitis?

PURPOSE

Although it is recognized that younger children have higher appendiceal perforation rates, little is known about the effect of age on postoperative morbidity. The purpose of this study was to determine whether age affects the outcome and management of pediatric appendicitis.

METHODS

A retrospective review of all patients 14 years and younger who were treated for appendicitis over a 10-year period was performed. Study outcomes included 30-day postoperative morbidity, use of laparoscopy, and length of hospitalization (LOH). Postoperative morbidity included rates of wound infection, postoperative abscess drainage, and readmission. Patients were categorized into 3 age groups: young (≤5 years), middle (6-9 years), and older (≥10 years). Data for univariate associations were analyzed using χ(2) and Wilcoxon rank sum tests and reported as medians with interquartile ranges (IQR). Study outcomes were also analyzed using multivariable regression.

RESULTS

Overall, 5894 patients were identified. Median age was 10.3 years (IQR 7.3-12.5), and 61% were boys. The perforation rate was highest for patients 5 years and younger (≤5 years, 51%; 6-9 years, 32%; ≥10 years, 27%; P < .0001). Multivariable analysis demonstrated that although the need for postoperative abscess drainage was greatest in older children (10-14 years), the readmission rate and LOH was highest in the youngest children (≤5 years). Wound infection rates were similar across all age groups.

CONCLUSIONS

Although older children had a higher risk of abscess drainage, younger children were more likely to have perforated appendicitis, be readmitted, and have longer LOH. Management of appendicitis differed according to age. Laparoscopic appendectomy was more frequently performed in older children, whereas the youngest children were more likely to be treated nonoperatively.