title: Minimizing unnecessary parenteral nutrition after appendectomy in children.
abstract: BACKGROUND
  Consensus guidelines have indicated that postoperative parenteral nutrition (PN) might provide benefit when patients are expected to be nil per os (NPO) ≥7 d and when PN is administered ≥5 d. We hypothesized that most children receiving PN after appendectomy do not satisfy these criteria.
  
  
  METHODS
  The medical records of the patients who had undergone appendectomy for perforated appendicitis from 2006-2011 were analyzed, and the proportion meeting the criteria for beneficial PN was determined. The clinical parameters independently associated with the criteria for beneficial PN (PN therapy ≥5 d, ileus ≥5 d, NPO ≥7 d) were identified using multiple regression analysis.
  
  
  RESULTS
  A total of 1612 patients were treated for appendicitis. Of these, 587 met the inclusion criteria (age <16 y, perforated appendicitis, appendectomy within 24 h, no previous indication for PN). Of the 587 patients, 12.1% received PN; 43.8% of these received PN for ≥5 d. The predictors of PN duration of ≥5 d included preoperative symptoms for ≥3 d (P < 0.01) and initiation of PN by postoperative day 3 (P = 0.047). Preoperative symptoms for ≥3 d, imaging showing a discrete abscess or bowel obstruction, and operative findings of diffuse peritonitis predicted ileus of ≥5 d and NPO of ≥7 d (P < 0.01 for all). Major complications were more common in patients with ileus lasting ≥5 d.
  
  
  CONCLUSIONS
  Fewer than one-half of patients receiving PN in the present cohort met the consensus-based guidelines for postoperative PN. The preoperative symptom duration, preoperative imaging findings demonstrating abscess and/or bowel obstruction, and intraoperative findings of diffuse peritonitis might predict prolonged ileus and longer recovery periods for children undergoing surgery for perforated appendicitis.
authors.affiliation: Division of Pediatric Surgery, Children's Hospital and Research Center at Oakland, Oakland, California 94609, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Bell
authors.forename: James
authors.initials: J
authors.lastname: Betts
authors.forename: Olajire
authors.initials: O
authors.lastname: Idowu
authors.forename: Wendy
authors.initials: W
authors.lastname: Su
authors.forename: Thomas
authors.initials: T
authors.lastname: Hui
authors.forename: Sunghoon
authors.initials: S
authors.lastname: Kim
authors.forename: Christopher
authors.initials: C
authors.lastname: Newton
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Stehr
mesh_terms: D001062:Appendectomy; D001064:Appendicitis / Q000453:epidemiology / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D045823:Ileus / Q000178:diet therapy / Q000453:epidemiology; D007415:Intestinal Obstruction / Q000178:diet therapy / Q000453:epidemiology; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D010288:Parenteral Nutrition; D010538:Peritonitis / Q000178:diet therapy; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000178:diet therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D019564:Unnecessary Procedures
keywords: Appendicitis; Children; Parenteral nutrition