title: Is it necessary to drain all postoperative fluid collections after appendectomy for perforated appendicitis?
abstract: OBJECTIVE
  Children treated for perforated appendicitis can have significant morbidity. Management often includes looking for and draining postoperative fluid collections. We sought to determine if drainage hastens recovery.
  
  
  METHODS
  Children with perforated appendicitis treated with appendectomy from 2006 to 2009 were reviewed. Patients with postoperative fluid that was drained were compared with patients with undrained fluid with regard to preoperative features and postoperative outcomes. Statistical analyses included paired Student's t tests, Mann-Whitney U test, and linear regression.
  
  
  RESULTS
  Five hundred ninety-one patients were reviewed. Seventy-one patients had postoperative fluid, of whom 36 had a drainage procedure and 35 did not. There was no significant difference in white blood cell count at the time of assessment for drainage (16.4 ± 4.0 vs 14.6 ± 4.9, P = .14), days with fever (3.5 ± 3.0 vs 2.9 ± 2.5, P = .35), or readmission rate (19% vs 31%, P = .28). After multivariate linear regression, larger fluid volumes were associated with prolonged length of stay (LOS) (P = .03). For fluid collections between 30-100 mL, there was no significant difference in LOS between the drain and no-drain groups (9.8 ± 3.5 vs 10.9 ± 5.2 days, P = .51).
  
  
  CONCLUSIONS
  After appendectomy for perforated appendicitis, larger postoperative fluid collections are associated with prolonged LOS. Drainage of collections less than 100 mL may not hasten recovery.
authors.affiliation: Department of Surgery, Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas, TX, USA. hannah.piper@sickkids.ca
authors.forename: Hannah G
authors.initials: HG
authors.lastname: Piper
authors.forename: Betul
authors.initials: B
authors.lastname: Derinkuyu
authors.forename: Korgun
authors.initials: K
authors.lastname: Koral
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Perez
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Murphy
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D001064:Appendicitis / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends*; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D019564:Unnecessary Procedures