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The Impact of Postoperative Abscess Formation in Perforated Appendicitis

Published:April 14, 2011DOI:https://doi.org/10.1016/j.jss.2011.03.038

      Background

      Abscess after appendectomy for perforated appendicitis is the most common complication. We have completed three prospective trials and are conducting a fourth in which the included patients had either a hole in the appendix or a fecalith in the abdomen identified at the time of operation. The abscess rate in each of these trials was 20%. Multiple publications have focused on prevention and management of this postoperative complication but the total impact of an abscess on the hospital course has not been well documented. Therefore, we reviewed our experience with patients who developed a postoperative abscess to evaluate the total care received compared with those who recovered uneventfully.

      Methods

      Data from patients with abscess who have been enrolled in our prospective trials from April 2005 to December 2009 were utilized. Patients who recovered without complications in the most recent trial served as a comparison group, as this protocol offers the minimal length of stay without a predetermined length of stay. Data comparison included patient demographics, admission lab values, hospital length of stay, and hospital charges.

      Results

      There were 63 patients with a postoperative abscess and 61 patients without an abscess identified. Patients with an abscess were older (11.0 versus 9.7 y, P = 0.04) and had a higher mean body mass index (22.4 versus 19.5, P = 0.03). Total hospital length of stay was significantly longer in the abscess group (11.6 d versus 5.1 d, P ≤ 0.001). Total hospital charges doubled for patients who developed an abscess ($82,000 versus $40,000 P < 0.001).

      Conclusion

      A postoperative abscess after appendectomy for perforated appendicitis translates into an average of an extra week in hospital care with double the total hospital cost.

      Key Words

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      References

        • Krisher S.L.
        • Browne A.
        • Dibbins A.
        • et al.
        Intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis.
        Arch Surg. 2001; 136: 438
        • St. Peter S.D.
        • Tsao K.
        • Spilde T.L.
        • et al.
        Single daily dosing ceftriaxone and metronidazole versus standard triple antibiotic regimen for perforated appendicitis in children: A prospective randomized trial.
        J Pediatr Surg. 2008; 43: 981
        • Fraser J.D.
        • Aguayo P.
        • Leys C.M.
        • et al.
        A complete course of intravenous antibiotics versus a combination of intravenous and oral antibiotics for perforated appendicitis in children: A prospective, randomized trial.
        J Pediatr Surg. 2010; 45: 1198
        • St. Peter S.D.
        • Aguayo P.
        • Fraser J.D.
        • et al.
        Initial laparoscopic appendectomy upon presentation versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: A prospective, randomized trial.
        J Pediatr Surg. 2010; 45: 236
      1. Irrigation versus no irrigation for perforated appendicitis. Clinicaltrials.gov. Registration number: NCT00854815.

        • St. Peter S.D.
        • Sharp S.W.
        • Holcomb III, G.W.
        • et al.
        An evidence-based definition for perforated appendicitis derived from a prospective randomized trial.
        J Pediatr Surg. 2008; 43: 2242
        • Addiss D.G.
        • Shaffer N.
        • Fowler B.S.
        • et al.
        The epidemiology of appendicitis and appendectomy in the United States.
        Am J Epidemiol. 1990; 132: 910
        • Davies G.M.
        • Dasbach E.J.
        • Teutsch S.
        The burden of appendicitis-related hospitalizations in the United States in 1997.
        Surg Infect. 2004; 5: 160
        • Livingston E.H.
        • Woodward W.A.
        • Sarosi G.A.
        • et al.
        Disconnect between incidence of nonperforated and perforated appendicitis. Implications for pathophysiology and management.
        Ann Surg. 2007; 245: 886
        • Fraser J.D.
        • Aguayo P.
        • Sharp S.W.
        • et al.
        Physiologic predictors of postoperative abscess in children with perforated appendicitis: Subset analysis from a prospective randomized trial.
        Surgery. 2010; 147: 729
        • Henry M.C.W.
        • Walker A.
        • Silverman B.L.
        • et al.
        Risk factors for the development of abdominal abscess following operation for perforated appendicitis in children.
        Arch Surg. 2007; 142: 236
        • Meier D.E.
        • Guzzetta P.C.
        • Barber R.G.
        • et al.
        Perforated appendicitis in children: Is there a best treatment.
        J Pediatr Surg. 2003; 38: 1520
        • Parcells J.P.
        • Mileski J.P.
        • Gnagy F.T.
        • et al.
        Using antimicrobial solution for irrigation in appendicitis to lower surgical site infection rates.
        Am J Surg. 2009; 198: 875
        • Hussain A.
        • Mahmood H.
        • Nicholls J.
        • et al.
        Prevention of intra-abdominal abscess following laparoscopic appendicectomy for perforated appendicitis: A prospective study.
        Int J Surg. 2008; 6: 374