Morbidity of peripherally inserted central catheters in pediatric complicated appendicitis.
BACKGROUND
The purpose of this study was to compare postoperative outcomes of pediatric patients with complicated appendicitis managed with or without a peripherally inserted central catheter (PICC).


METHODS
Patients aged ≤18 y in the Pediatric Health Information System database with complicated appendicitis that underwent appendectomy during their index admission in 2000-2012 were grouped by whether they had a PICC placed using relevant procedure and billing codes. Rates of subsequent encounters within 30 d of discharge along with associated diagnoses and procedures were determined. A propensity score-matched (PSM) analysis was performed to account for differences in baseline exposures and severity of illness.


RESULTS
We included 33,482 patients with complicated appendicitis; of whom, 6620 (19.8%) received a PICC and 26,862 (80.2%) did not. The PICC group had a longer postoperative length of stay (median 7 versus 5 d, P<0.001) and were more likely to undergo intra-abdominal abscess drainage during the index admission (14.4% versus 2.1%, P<0.001), and have a reencounter (17.5% versus 11.4%, P<0.001) within 30 d of discharge. However, in the PSM cohort (n=4428 in each group), outcomes did not differ between treatment groups, although the PICC group did have increased odds for the development of other postoperative complications (odds ratio=3.95, 95% confidence interval: 1.45, 10.71).


CONCLUSIONS
After accounting for differences in severity of illness by PSM, patients managed with PICCs had a similar risk for nearly all postoperative complications, including reencounters. Postoperative management of pediatric complicated appendicitis with a PICC is not clearly associated with improved outcomes.
Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
Jason P
JP
Sulkowski
Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
Lindsey
L
Asti
Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
Jennifer N
JN
Cooper
Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
Brian D
BD
Kenney
Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
Mehul V
MV
Raval
Department of Surgery, Children's Hospital Boston, Boston, Massachusetts.
Shawn J
SJ
Rangel
Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
Katherine J
KJ
Deans
Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio. Electronic address: peter.minneci@nationwidechildrens.org.
Peter C
PC
Minneci
D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D063005:Health Information Systems; D006801:Humans; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D057216:Propensity Score
D000900:Anti-Bacterial Agents
Appendicitis; Complicated appendicitis; PHIS; PICC; Pediatric Health Information System; Peripherally inserted central catheter