Does age affect the outcomes and management of pediatric appendicitis in Taiwan?

Hung-Chieh Lo, Wen Kuei Chien, Chen Sheng Huang, Sheng Mao Wu, Hung Chang Huang, Ray Jade Chen, Chih Cheng Luo

Research output: Contribution to journalArticle

Abstract

Background/Introduction: Despite advances in ultrasound and computed tomography, perforation rates in children ≤6 years of age have been reported to range from 54%-74% over the past three decades according to two previous reports. The comprehensive coverage offered by the Taiwan National Health Insurance program enabled us to effectively evaluate the effect of age on postoperative morbidity. Purpose(s)/Aim(s): To investigate whether age affected the outcomes and management of appendicitis in children in Taiwan. Methods: We used the Collaboration Center for Health Information Application database to identify 21,827 patients ≤18 years of age who had been hospitalized with a diagnosis of acute appendicitis between 2007 and 2012 in Taiwan. Study outcomes included postoperative morbidity, undergoing laparoscopic appendectomy (LA) or open appendectomy, and the length of hospitalization. Postoperative morbidity included the incidence of intra-abdominal abscesses (IAAs) and postoperative bowel obstructions (PBOs). Patients were divided into three age groups: ≤6 years, 7-12 years, and 13-18 years. Data for univariate associations were computed using a chi-square test. The odds ratios (ORs) and 95% confidence intervals (CIs) of IAA and PBO risk factors were derived from the multivariate logistic regression models. Results: Overall, an LA was used in only 41% of children, and the total IAA and PBO complication rates were 1.8% and 0.6%, respectively. The perforation rate was highest for patients ≤6 years old at 51% as compared with 32% of patients aged 7-12 years and 24% of those aged 13-18 years (p < 0.0001). An LA was least often performed in younger children [24% of patients aged ≤6 years, 37% of those aged 7-12 years, and 44% of those aged 13-18 years (p < 0.0001)]. In the multivariable analysis, the adjusted ORs for IAAs and PBOs for patients aged 7-12 years and 13-18 years who had a perforated appendicitis and underwent an LA were 0.66 (95% CI: 0.47-0.93; . p = 0.0182) and 0.51 (95% CI: 0.37-0.72; . p = 0.0001) and 0.49 (95% CI: 0.28-0.86; p = 0.0125) and 0.41 (95% CI: 0.23-0.71; p = 0.0014), respectively, as compared with those aged ≤6 years. Conclusion: Our study demonstrated that children in the youngest age group (≤6 years) had a high rate of appendix perforation and required fewer LAs. When LAs were performed on children in this age group to treat perforated appendicitis, IAA and PBO risks were higher than in other older age groups.

Original languageEnglish
JournalFormosan Journal of Surgery
DOIs
Publication statusAccepted/In press - Jan 5 2016

Fingerprint

Abdominal Abscess
Appendicitis
Appendectomy
Taiwan
Pediatrics
Confidence Intervals
Age Groups
National Health Programs
Morbidity
Logistic Models
Odds Ratio
Information Centers
Chi-Square Distribution
Hospitalization
Tomography
Outcome Assessment (Health Care)
Databases
Incidence
Health

Keywords

  • Age
  • Intra-abdominal abscess (IAA)
  • Laparoscopic appendectomy (LA)
  • Open appendectomy (OA)
  • Postoperative bowel obstruction (PBB)

ASJC Scopus subject areas

  • Surgery

Cite this

Does age affect the outcomes and management of pediatric appendicitis in Taiwan? / Lo, Hung-Chieh; Chien, Wen Kuei; Huang, Chen Sheng; Wu, Sheng Mao; Huang, Hung Chang; Chen, Ray Jade; Luo, Chih Cheng.

In: Formosan Journal of Surgery, 05.01.2016.

Research output: Contribution to journalArticle

Lo, Hung-Chieh ; Chien, Wen Kuei ; Huang, Chen Sheng ; Wu, Sheng Mao ; Huang, Hung Chang ; Chen, Ray Jade ; Luo, Chih Cheng. / Does age affect the outcomes and management of pediatric appendicitis in Taiwan?. In: Formosan Journal of Surgery. 2016.
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title = "Does age affect the outcomes and management of pediatric appendicitis in Taiwan?",
abstract = "Background/Introduction: Despite advances in ultrasound and computed tomography, perforation rates in children ≤6 years of age have been reported to range from 54{\%}-74{\%} over the past three decades according to two previous reports. The comprehensive coverage offered by the Taiwan National Health Insurance program enabled us to effectively evaluate the effect of age on postoperative morbidity. Purpose(s)/Aim(s): To investigate whether age affected the outcomes and management of appendicitis in children in Taiwan. Methods: We used the Collaboration Center for Health Information Application database to identify 21,827 patients ≤18 years of age who had been hospitalized with a diagnosis of acute appendicitis between 2007 and 2012 in Taiwan. Study outcomes included postoperative morbidity, undergoing laparoscopic appendectomy (LA) or open appendectomy, and the length of hospitalization. Postoperative morbidity included the incidence of intra-abdominal abscesses (IAAs) and postoperative bowel obstructions (PBOs). Patients were divided into three age groups: ≤6 years, 7-12 years, and 13-18 years. Data for univariate associations were computed using a chi-square test. The odds ratios (ORs) and 95{\%} confidence intervals (CIs) of IAA and PBO risk factors were derived from the multivariate logistic regression models. Results: Overall, an LA was used in only 41{\%} of children, and the total IAA and PBO complication rates were 1.8{\%} and 0.6{\%}, respectively. The perforation rate was highest for patients ≤6 years old at 51{\%} as compared with 32{\%} of patients aged 7-12 years and 24{\%} of those aged 13-18 years (p < 0.0001). An LA was least often performed in younger children [24{\%} of patients aged ≤6 years, 37{\%} of those aged 7-12 years, and 44{\%} of those aged 13-18 years (p < 0.0001)]. In the multivariable analysis, the adjusted ORs for IAAs and PBOs for patients aged 7-12 years and 13-18 years who had a perforated appendicitis and underwent an LA were 0.66 (95{\%} CI: 0.47-0.93; . p = 0.0182) and 0.51 (95{\%} CI: 0.37-0.72; . p = 0.0001) and 0.49 (95{\%} CI: 0.28-0.86; p = 0.0125) and 0.41 (95{\%} CI: 0.23-0.71; p = 0.0014), respectively, as compared with those aged ≤6 years. Conclusion: Our study demonstrated that children in the youngest age group (≤6 years) had a high rate of appendix perforation and required fewer LAs. When LAs were performed on children in this age group to treat perforated appendicitis, IAA and PBO risks were higher than in other older age groups.",
keywords = "Age, Intra-abdominal abscess (IAA), Laparoscopic appendectomy (LA), Open appendectomy (OA), Postoperative bowel obstruction (PBB)",
author = "Hung-Chieh Lo and Chien, {Wen Kuei} and Huang, {Chen Sheng} and Wu, {Sheng Mao} and Huang, {Hung Chang} and Chen, {Ray Jade} and Luo, {Chih Cheng}",
year = "2016",
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language = "English",
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issn = "1011-6788",
publisher = "臺灣外科醫學會",

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T1 - Does age affect the outcomes and management of pediatric appendicitis in Taiwan?

AU - Lo, Hung-Chieh

AU - Chien, Wen Kuei

AU - Huang, Chen Sheng

AU - Wu, Sheng Mao

AU - Huang, Hung Chang

AU - Chen, Ray Jade

AU - Luo, Chih Cheng

PY - 2016/1/5

Y1 - 2016/1/5

N2 - Background/Introduction: Despite advances in ultrasound and computed tomography, perforation rates in children ≤6 years of age have been reported to range from 54%-74% over the past three decades according to two previous reports. The comprehensive coverage offered by the Taiwan National Health Insurance program enabled us to effectively evaluate the effect of age on postoperative morbidity. Purpose(s)/Aim(s): To investigate whether age affected the outcomes and management of appendicitis in children in Taiwan. Methods: We used the Collaboration Center for Health Information Application database to identify 21,827 patients ≤18 years of age who had been hospitalized with a diagnosis of acute appendicitis between 2007 and 2012 in Taiwan. Study outcomes included postoperative morbidity, undergoing laparoscopic appendectomy (LA) or open appendectomy, and the length of hospitalization. Postoperative morbidity included the incidence of intra-abdominal abscesses (IAAs) and postoperative bowel obstructions (PBOs). Patients were divided into three age groups: ≤6 years, 7-12 years, and 13-18 years. Data for univariate associations were computed using a chi-square test. The odds ratios (ORs) and 95% confidence intervals (CIs) of IAA and PBO risk factors were derived from the multivariate logistic regression models. Results: Overall, an LA was used in only 41% of children, and the total IAA and PBO complication rates were 1.8% and 0.6%, respectively. The perforation rate was highest for patients ≤6 years old at 51% as compared with 32% of patients aged 7-12 years and 24% of those aged 13-18 years (p < 0.0001). An LA was least often performed in younger children [24% of patients aged ≤6 years, 37% of those aged 7-12 years, and 44% of those aged 13-18 years (p < 0.0001)]. In the multivariable analysis, the adjusted ORs for IAAs and PBOs for patients aged 7-12 years and 13-18 years who had a perforated appendicitis and underwent an LA were 0.66 (95% CI: 0.47-0.93; . p = 0.0182) and 0.51 (95% CI: 0.37-0.72; . p = 0.0001) and 0.49 (95% CI: 0.28-0.86; p = 0.0125) and 0.41 (95% CI: 0.23-0.71; p = 0.0014), respectively, as compared with those aged ≤6 years. Conclusion: Our study demonstrated that children in the youngest age group (≤6 years) had a high rate of appendix perforation and required fewer LAs. When LAs were performed on children in this age group to treat perforated appendicitis, IAA and PBO risks were higher than in other older age groups.

AB - Background/Introduction: Despite advances in ultrasound and computed tomography, perforation rates in children ≤6 years of age have been reported to range from 54%-74% over the past three decades according to two previous reports. The comprehensive coverage offered by the Taiwan National Health Insurance program enabled us to effectively evaluate the effect of age on postoperative morbidity. Purpose(s)/Aim(s): To investigate whether age affected the outcomes and management of appendicitis in children in Taiwan. Methods: We used the Collaboration Center for Health Information Application database to identify 21,827 patients ≤18 years of age who had been hospitalized with a diagnosis of acute appendicitis between 2007 and 2012 in Taiwan. Study outcomes included postoperative morbidity, undergoing laparoscopic appendectomy (LA) or open appendectomy, and the length of hospitalization. Postoperative morbidity included the incidence of intra-abdominal abscesses (IAAs) and postoperative bowel obstructions (PBOs). Patients were divided into three age groups: ≤6 years, 7-12 years, and 13-18 years. Data for univariate associations were computed using a chi-square test. The odds ratios (ORs) and 95% confidence intervals (CIs) of IAA and PBO risk factors were derived from the multivariate logistic regression models. Results: Overall, an LA was used in only 41% of children, and the total IAA and PBO complication rates were 1.8% and 0.6%, respectively. The perforation rate was highest for patients ≤6 years old at 51% as compared with 32% of patients aged 7-12 years and 24% of those aged 13-18 years (p < 0.0001). An LA was least often performed in younger children [24% of patients aged ≤6 years, 37% of those aged 7-12 years, and 44% of those aged 13-18 years (p < 0.0001)]. In the multivariable analysis, the adjusted ORs for IAAs and PBOs for patients aged 7-12 years and 13-18 years who had a perforated appendicitis and underwent an LA were 0.66 (95% CI: 0.47-0.93; . p = 0.0182) and 0.51 (95% CI: 0.37-0.72; . p = 0.0001) and 0.49 (95% CI: 0.28-0.86; p = 0.0125) and 0.41 (95% CI: 0.23-0.71; p = 0.0014), respectively, as compared with those aged ≤6 years. Conclusion: Our study demonstrated that children in the youngest age group (≤6 years) had a high rate of appendix perforation and required fewer LAs. When LAs were performed on children in this age group to treat perforated appendicitis, IAA and PBO risks were higher than in other older age groups.

KW - Age

KW - Intra-abdominal abscess (IAA)

KW - Laparoscopic appendectomy (LA)

KW - Open appendectomy (OA)

KW - Postoperative bowel obstruction (PBB)

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