title: Does delay in appendectomy affect surgical site infection in children with appendicitis?
abstract: OBJECTIVE
  The purpose of this study was to investigate the association between time from diagnosis to operation and surgical site infection (SSI) in children undergoing appendectomy.
  
  
  METHODS
  Pediatric patients undergoing appendectomy in 2010-2012 were included. We collected data on patient demographics; length of symptoms; times of presentation, admission and surgery; antibiotic administration; operative findings; and occurrence of SSI.
  
  
  RESULTS
  1388 patients were analyzed. SSI occurred in 5.1% of all patients, 1.4% of simple appendicitis (SA) patients, and 12.4% of complex appendicitis (CA) patients. SSI did not increase significantly as the length of time between ED triage and operation increased (all patients, p=0.51; SA patients, p=0.91; CA patients, p=0.44) or with increased time from admission to operation (all patients, p=0.997; SA patients, p=0.69; CA patients, p=0.96). However, greater length of symptoms was associated with an increased risk of SSI (p<0.05 for all, SA and CA patients). In univariable analysis, obesity, and increased admission WBC count were each associated with significantly increased SSI. In multivariable analysis, only CA was a significant risk factor for SSI (p<0.0001).
  
  
  CONCLUSIONS
  We found no significant increase in the risk of SSI related to delay in appendectomy. A future multi-institutional study is planned to confirm these results.
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Boomer
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Cooper
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Leonhart
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Diefenbach
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Kenney
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: gail.besner@nationwidechildrens.org.
authors.forename: Gail E
authors.initials: GE
authors.lastname: Besner
mesh_terms: D000208:Acute Disease; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay / Q000639:trends; D008297:Male; D009820:Ohio / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D013997:Time Factors
keywords: Appendectomy; Complex appendicitis; Elevated leukocyte count; Laparoscopic conversion; Obesity; Surgical site infection