title: Pediatric surgeon vs general surgeon: does subspecialty training affect the outcome of appendicitis?
abstract: BACKGROUND
  The absence of pediatric surgeons in many centers results in restriction of patient access to pediatric subspecialty care. The aim of this study was to compare the outcomes of children treated for appendicitis by pediatric surgeons (PS) and by general surgeons (GS).
  
  
  METHODS
  This was a retrospective review of the charts of all consecutive patients <16 years old who underwent appendectomy during 2 years The primary outcome measure was the overall rate of complications. Secondary outcome measures included length of hospital stay (LOS), symptom duration, time from emergency department diagnosis to surgery, and readmission rate within 30 days.
  
  
  RESULTS
  A total of 94 patients (PS group, n = 66; GS group, n = 28) were included. PS patients were younger. For patients with complicated appendicitis, complications were significantly more prevalent in the GS group (57% vs 15%; P = 0.0001). Median LOS was not significantly different between the two groups for complicated appendicitis, but patients with non-complicated appendicitis had a significant longer LOS when treated by PS (3.74 ± 1.5 vs 2.57 ± 1.21 days; P = 0.0041). Patients in the PS group had a prolonged use of antibiotics (2 vs 4 days; P = 0.001), and longer LOS (3 vs 4 days; P = 0.0018).
  
  
  CONCLUSIONS
  Overall complication rates were similar between PS and GS. Complications were significantly more prevalent in patients with complicated appendicitis who were treated by GS.
authors.affiliation: Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal (HSPM), São Paulo, Brazil.
authors.forename: Paulo Sérgio Lucas
authors.initials: PS
authors.lastname: da Silva
authors.forename: Vânia Euzébio
authors.initials: VE
authors.lastname: de Aguiar
authors.forename: Jaques
authors.initials: J
authors.lastname: Waisberg
mesh_terms: D001062:Appendectomy / Q000193:education; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D013502:General Surgery; D006801:Humans; D008297:Male; D010372:Pediatrics; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013043:Specialties, Surgical; D016896:Treatment Outcome
keywords: appendectomy; child; general surgery; outcome; pediatrics