{"title":"患有神经发育障碍的儿童阑尾炎的预后更差","authors":"Su Yeon Lee , Emily A Byrd , Jonathan E Kohler","doi":"10.1016/j.yjpso.2025.100210","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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”.</div></div><div><h3>Results</h3><div>97,236 patients met inclusion criteria. NDD patients underwent interval appendectomy at significantly higher rates compared to neurotypical patients (4.19 % vs. 2.62 %, <em>p</em> < 0.0001). Of patients undergoing appendectomy during index presentation, 1688 (1.80 %) had “developmental delay” diagnosis. Complicated appendicitis (33.77 % vs. 27.79 %, <em>p</em> < 0.0001) and normal appendix (4.03 % vs. 2.38 %, <em>p</em> < 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, <em>p</em> < 0.0001). Patients with NDD had more frequent post-operative ED visits (11.32 % vs. 7.76 %, <em>p</em> < 0.0001) and higher 30-day readmission rates (15.86 % vs. 8.21 %, <em>p</em> < 0.0001), but lower rates of readmission related to appendectomy (76.19 % vs. 86.57 %, <em>p</em> = 0.002).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"11 ","pages":"Article 100210"},"PeriodicalIF":0.0000,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Children with neurodevelopmental disabilities have worse appendicitis outcomes\",\"authors\":\"Su Yeon Lee , Emily A Byrd , Jonathan E Kohler\",\"doi\":\"10.1016/j.yjpso.2025.100210\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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”.</div></div><div><h3>Results</h3><div>97,236 patients met inclusion criteria. NDD patients underwent interval appendectomy at significantly higher rates compared to neurotypical patients (4.19 % vs. 2.62 %, <em>p</em> < 0.0001). Of patients undergoing appendectomy during index presentation, 1688 (1.80 %) had “developmental delay” diagnosis. Complicated appendicitis (33.77 % vs. 27.79 %, <em>p</em> < 0.0001) and normal appendix (4.03 % vs. 2.38 %, <em>p</em> < 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, <em>p</em> < 0.0001). Patients with NDD had more frequent post-operative ED visits (11.32 % vs. 7.76 %, <em>p</em> < 0.0001) and higher 30-day readmission rates (15.86 % vs. 8.21 %, <em>p</em> < 0.0001), but lower rates of readmission related to appendectomy (76.19 % vs. 86.57 %, <em>p</em> = 0.002).</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":100821,\"journal\":{\"name\":\"Journal of Pediatric Surgery Open\",\"volume\":\"11 \",\"pages\":\"Article 100210\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-04-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pediatric Surgery Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S294971162500019X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatric Surgery Open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S294971162500019X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的阑尾炎是儿童最常见的外科急症。患有神经发育障碍(NDD)的儿童有沟通差异,这可能会使他们的医疗护理复杂化。我们假设患有NDD的儿童更有可能出现更严重的阑尾炎,并且有更差的临床结果。方法:我们使用国家儿科外科质量改进计划(NSQIP-P)数据库对2015年至2020年进行的阑尾切除术进行研究。主要结局为并发阑尾炎。比较有无建立的NSQIP-P变量“发育迟缓”的患者的结果。结果97236例患者符合纳入标准。NDD患者行间歇阑尾切除术的比例明显高于神经正常患者(4.19% vs. 2.62%, p <;0.0001)。在指数表现期间行阑尾切除术的患者中,1688例(1.80%)诊断为“发育迟缓”。并发阑尾炎(33.77% vs. 27.79%, p <;0.0001)和正常阑尾(4.03% vs. 2.38%, p <;0.0001)在NDD患者中均明显更常见。NDD患者的住院时间较长(1.048,95% CI 1.039-1.057, p <;0.0001)。NDD患者术后急诊科就诊频率更高(11.32% vs. 7.76%, p <;0.0001)和更高的30天再入院率(15.86%对8.21%,p <;0.0001),但与阑尾切除术相关的再入院率较低(76.19%对86.57%,p = 0.002)。结论神经发育障碍患者并发阑尾炎的发生率较高,术后护理更为复杂。这些患者代表了一个独特的患者群体,在阑尾炎的评估和治疗过程中需要适应性的管理策略。在对患有NDD和阑尾炎的儿童进行诊断、围手术期和术后处理时,将对NDD的认识纳入其检查是至关重要的。
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.