Statewide Analysis of Pediatric Appendicitis Outcomes by Pediatric Surgeon Availability

Abstract

Introduction

Appendicitis is common in children, treated by both pediatric and general surgeons at hospitals with varying specialization levels of pediatric care. We evaluated differences in treatment and outcomes by pediatric surgeon coverage using California's Department of Health Care Access and Information Database.

Methods

Children (≤17 y) with acute appendicitis (2019-2021) were identified. Those with significant comorbidities or could not be followed longitudinally were excluded. Hospitals were categorized as exclusively free-standing children's hospitals (ECH), other hospitals with pediatric surgeon coverage (WPS) or no pediatric surgeon coverage (NPS). Outcomes of initial intervention (appendectomy/drainage/nonoperative), readmissions, and complications were analyzed and stratified by appendicitis type (simple versus complicated).

Results

Of 7059 included patients, 33% were treated at ECH, 28% at WPS, and 39% at NPS. There were no differences in any outcomes for patients with simple appendicitis. Complicated appendicitis (n = 2755) was treated in greater proportions at ECH (43% ECH versus 38% WPS versus 37% NPS, P < 0.01). In complicated appendicitis, initial drain management was rare (n = 179) but more common in patients at ECH (9.1% ECH versus 5.2% WPS versus 4.9% NPS, P < 0.01). Readmissions were also rare (n = 181) but higher at ECH (8.4% versus 5% at NPS and WPS). Overall complication rates for complicated appendicitis did not differ by hospital type.

Conclusions

Although treatment strategies for appendicitis differed by hospital type, complication rates were equivalent regardless of surgeon coverage by hospital type. These results demonstrate that children with appendicitis in California overwhelmingly have positive outcomes regardless of the hospital's level of specialization in pediatric care.