Physiologic predictors of postoperative abscess in children with perforated appendicitis: subset analysis from a prospective randomized trial.
BACKGROUND
Intra-abdominal abscess after appendectomy is the most common complication in patients with perforated appendicitis. There are currently little data that may forecast which patients are more likely to develop an abscess. Therefore, we performed a retrospective analysis of a prospectively collected dataset to determine whether there are predictors for developing a postoperative abscess.


METHODS
The dataset was collected prospectively in a randomized trial comparing antibiotic regimens in 98 pediatric patients with perforated appendicitis. All patients underwent laparoscopic appendectomy and received a minimum of 5 days of intravenous antibiotics. The Pearson correlation was used to evaluate the influence of patient, intra-operative, and early postoperative variables on the development of an abscess. Two-tailed P values were determined from the correlation coefficient, and significance was defined as P < or = .05.


RESULTS
At presentation, a positive correlation for abscess formation was identified with increasing age (P = .003), weight (P = .001), body mass index (P = .008), and diarrhea (P = .005). Operative time had no influence on abscess development. After operation, there was progressively increasing positive correlation between abscess and the maximum temperature each successive postoperative day. This relationship became significant at day 3. An increased white blood cell count on day 5 was highly predictive of abscess (P < .001).


CONCLUSIONS
In children presenting with perforated appendicitis, increasing age, weight, and/or body mass index correlated with the development of a postoperative abscess. Diarrhea on presentation also poses an increased risk of abscess. Postoperatively, each successive day with a fever is incrementally more predictive of an abscess formation.
Fraser
Jason D
JD
Department of Surgery, Center for Prospective Clinical Trials, Children's Mercy Hospital, 2401 Gilham Road, Kansas City, MO 64108, USA.
Aguayo
Pablo
P
Sharp
Susan W
SW
Snyder
Charles L
CL
Holcomb
George W
GW
Ostlie
Daniel J
DJ
St Peter
Shawn D
SD
D018784:Abdominal Abscess / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001064:Appendicitis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D015992:Body Mass Index; D002648:Child; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005260:Female; D005334:Fever / Q000453:epidemiology; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control
D000900:Anti-Bacterial Agents