Effect of subspecialty training on outcome after pediatric appendectomy.
OBJECTIVE
There have been few studies documenting the effect of subspecialty training on outcomes after appendectomy in children. Some studies have suggested a better outcome in patients managed by pediatric surgeons as compared with general surgeons.


METHODS
We studied the effect of subspecialty training on clinical outcome and negative appendectomy rate after pediatric appendectomy. Children less than 19 years in Ontario who underwent appendectomy were identified. Outcomes were compared between pediatric and general surgeons. Subanalyses were conducted for the age groups 0 to 5, 6 to 12, and 13 to 18 years.


RESULTS
Over 8 years, 24,019 children underwent appendectomy with a preoperative diagnosis of appendicitis. Of these, 21,027 had appendicitis. General surgeons performed 81.2% of the operations. Negative appendectomy rates were 8.3% and 13.4% (P < .0001) in the pediatric and general surgeon groups, respectively. Children operated on by pediatric surgeons were younger (10.5 +/- 3.6 vs 12.8 +/- 3.8; P < .05), more likely to be perforated (36.6% vs 32.0%; P < .0001), and had a longer postoperative stay (3.8 vs 3.0 days; P < .0001). There was no difference between groups with respect to wound infection or readmission rate when age and perforation status were accounted for.


CONCLUSIONS
Pediatric surgeons performed significantly fewer negative appendectomies than general surgeons. Although pediatric surgeons kept their patients longer in the hospital, their patients' wound infection and readmission rates were not different from that of the patients of general surgeons.
Somme
Stig
S
Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
To
Teresa
T
Langer
Jacob C
JC
D000293:Adolescent; D001062:Appendectomy / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D006801:Humans; D009864:Ontario; D011183:Postoperative Complications / Q000453:epidemiology*; D013043:Specialties, Surgical / Q000706:statistics & numerical data*; D016896:Treatment Outcome