Comparison of childhood appendicitis management in the regional paediatric surgery unit and the district general hospital

J Pediatr Surg. 2010 Feb;45(2):300-2. doi: 10.1016/j.jpedsurg.2009.10.079.


Background/purpose: Ongoing debate surrounds the future provision of general paediatric surgery. The aim of this study was to compare outcomes for childhood appendicitis managed in a district general hospital (DGH) and a regional paediatric surgical unit (RU).

Methods: Data collected retrospectively for a 2-year period in a DGH were compared with data collected prospectively for 1 year in an RU, where appendicitis management is guided by a care pathway. Children aged 6 to 15 years were included.

Results: Four hundred and two patients were included (DGH ,196; RU, 206). There were more cases of gangrenous/perforated appendicitis in the RU (P < .0001). In the DGH, fewer patients received preoperative antibiotics (P < .0001) or underwent preoperative pain scoring (P < .0001). When adjusted for case mix, the relative risk of complications for a child managed at the DGH was 1.76 (95% confidence interval, 1.44-2.16; P < .0001) and that of readmission was 1.76 (95% confidence interval, 1.43-2.16; P < .0001) when compared with the RU.

Conclusions: Patients with appendicitis managed in the DGH had a higher risk of complications and readmission. However, this appears to be related to the use of a care pathway at the RU. Introduction of a care pathway in the DGH may improve outcomes and thus support the ongoing provision of general paediatric surgery.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Antibiotic Prophylaxis
  • Appendectomy / methods*
  • Appendicitis / surgery*
  • Child
  • Critical Pathways
  • Female
  • Health Care Surveys*
  • Hospitals, District / standards
  • Hospitals, District / statistics & numerical data*
  • Hospitals, General / statistics & numerical data
  • Humans
  • Intestinal Perforation / surgery
  • Male
  • Pediatrics
  • Postoperative Complications / surgery
  • Preoperative Care
  • Retrospective Studies
  • Risk Assessment
  • Surgery Department, Hospital / standards
  • Surgery Department, Hospital / statistics & numerical data
  • Treatment Outcome