title: Determinants of postoperative abscess occurrence and percutaneous drainage in children with perforated appendicitis.
abstract: OBJECTIVE
  Postoperative abscesses after perforated appendicitis have no clear risk factors or indications for percutaneous drainage. Our study addressed these two issues.
  
  
  METHODS
  A logistic regression model was used to delineate risk factors for postoperative abscess in children with perforated appendicitis treated during a recent 5-year period. Drainage of abscess was compared to antibiotic treatment.
  
  
  RESULTS
  Postoperative abscess occurred in 42 (14.8%) of 284 patients. Higher WBC count, presence of bowel obstruction at presentation, diffuse peritonitis with a dominant abscess at surgery, and one specific surgeon were significantly associated with postoperative abscess, while fever or pain requiring narcotics at the time of abscess diagnosis was significantly associated with drainage. Compared to non-drainage, those drained had longer hospital stay including readmissions (15.9 ± 5.3 vs. 12.2 ± 4.6 days, p < 0.005) and less readmissions (9.5 vs. 33.3%, p = 0.06). Over the 5-year period, there was no increased trend in abscess occurrence (p = 0.56), but there was an increased trend in the use of percutaneous drainage (p = 0.02).
  
  
  CONCLUSIONS
  The risk of a postoperative abscess can be predicted by specific clinical characteristics, surgical findings, and treatment-related factors. Percutaneous drainage was associated with longer hospital stays, but less readmissions.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, 2300 Tupper, C-818, Montreal, QC, H3H 1P3, Canada, Sherif.Emil@McGill.ca.
authors.forename: Sherif
authors.initials: S
authors.lastname: Emil
authors.forename: Sherif
authors.initials: S
authors.lastname: Elkady
authors.forename: Layla
authors.initials: L
authors.lastname: Shbat
authors.forename: Fouad
authors.initials: F
authors.lastname: Youssef
authors.forename: Robert
authors.initials: R
authors.lastname: Baird
authors.forename: Jean-Martin
authors.initials: JM
authors.lastname: Laberge
authors.forename: Pramod
authors.initials: P
authors.lastname: Puligandla
authors.forename: Kenneth
authors.initials: K
authors.lastname: Shaw
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology* / Q000601:surgery; D001062:Appendectomy / Q000009:adverse effects*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013997:Time Factors