Children with neurodevelopmental disabilities have worse appendicitis outcomes

Objectives

Appendicitis is the most common surgical emergency in children. Children with neurodevelopmental disabilities (NDD) have communication differences that can complicate their medical care. We hypothesized that children with NDD are more likely to present with more severe appendicitis and have worse clinical outcomes.

Methods

We used the National Surgical Quality Improvement Program Pediatric (NSQIP-P) database to study appendectomies performed between 2015 and 2020. The primary outcome was complicated appendicitis. Outcomes were compared between patients with and without the established NSQIP-P variable for “developmental delay”.

Results

97,236 patients met inclusion criteria. NDD patients underwent interval appendectomy at significantly higher rates compared to neurotypical patients (4.19 % vs. 2.62 %, p < 0.0001). Of patients undergoing appendectomy during index presentation, 1688 (1.80 %) had “developmental delay” diagnosis. Complicated appendicitis (33.77 % vs. 27.79 %, p < 0.0001) and normal appendix (4.03 % vs. 2.38 %, p < 0.0001) were both significantly more frequent in NDD patients. NDD patients had longer length of stay (1.048, 95 % CI 1.039–1.057, p < 0.0001). Patients with NDD had more frequent post-operative ED visits (11.32 % vs. 7.76 %, p < 0.0001) and higher 30-day readmission rates (15.86 % vs. 8.21 %, p < 0.0001), but lower rates of readmission related to appendectomy (76.19 % vs. 86.57 %, p = 0.002).

Conclusions

Patients with neurodevelopmental disabilities have higher rates of complicated appendicitis resulting in more complex post-operative care. These patients represent a distinct patient population that require adaptive management strategies during evaluation and treatment of appendicitis. During diagnosis, peri‑operative, and post-operative management of children with NDD and appendicitis, it is vital to incorporate appreciation of NDD in their workup.