Comparison of childhood appendicitis management in the regional paediatric surgery unit and the district general hospital.
OBJECTIVE
Ongoing debate surrounds the future provision of general paediatric surgery. The aim of this study was to compare outcomes for childhood appendicitis managed in a district general hospital (DGH) and a regional paediatric surgical unit (RU).


METHODS
Data collected retrospectively for a 2-year period in a DGH were compared with data collected prospectively for 1 year in an RU, where appendicitis management is guided by a care pathway. Children aged 6 to 15 years were included.


RESULTS
Four hundred and two patients were included (DGH ,196; RU, 206). There were more cases of gangrenous/perforated appendicitis in the RU (P < .0001). In the DGH, fewer patients received preoperative antibiotics (P < .0001) or underwent preoperative pain scoring (P < .0001). When adjusted for case mix, the relative risk of complications for a child managed at the DGH was 1.76 (95% confidence interval, 1.44-2.16; P < .0001) and that of readmission was 1.76 (95% confidence interval, 1.43-2.16; P < .0001) when compared with the RU.


CONCLUSIONS
Patients with appendicitis managed in the DGH had a higher risk of complications and readmission. However, this appears to be related to the use of a care pathway at the RU. Introduction of a care pathway in the DGH may improve outcomes and thus support the ongoing provision of general paediatric surgery.
Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, L12 2AP Liverpool, UK.
Hannah L
HL
Collins
Sarah L
SL
Almond
Ben
B
Thompson
David
D
Lacy
Martin
M
Greaney
Colin T
CT
Baillie
Simon E
SE
Kenny
D000293:Adolescent; D019072:Antibiotic Prophylaxis; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D019091:Critical Pathways; D005260:Female; D019538:Health Care Surveys; D006767:Hospitals, District / Q000592:standards / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery; D008297:Male; D010372:Pediatrics; D011183:Postoperative Complications / Q000601:surgery; D011300:Preoperative Care; D012189:Retrospective Studies; D018570:Risk Assessment; D013503:Surgery Department, Hospital / Q000592:standards / Q000706:statistics & numerical data; D016896:Treatment Outcome