title: Pediatric Emergency Appendectomy and 30-Day Postoperative Outcomes in District General Hospitals and Specialist Pediatric Surgical Centers in England, April 2001 to March 2012: Retrospective Cohort Study.
abstract: OBJECTIVE
  To compare trends in pediatric emergency appendectomy and adverse surgical outcomes between district general hospitals (DGHs) and specialist pediatric centers (SPCs).
  
  
  BACKGROUND
  In the past decades in England, a significant reduction in the number of children operated by adult general surgeons has raised concerns about their surgical outcomes compared with specialist pediatric surgeons.
  
  
  METHODS
  Using Hospital Episode Statistics, we analyzed patient-level data between April 2001 and March 2012. Main inclusion criteria were children younger than 16 years admitted to NHS-England hospitals for an emergency appendectomy. Main outcomes were annual age-sex adjusted appendectomy rates and postoperative risk of readmission, complication, and reintervention.
  
  
  RESULTS
  A total of 83,679 emergency pediatric appendectomies were performed in 21 SPCs and 183 DGHs in England. SPCs performed only 18% of these operations (15,002). Annual age-sex standardized appendectomy rates fell from 87 to 68 per 100,000 population at an estimated 2% (rate ratio, 0.98) fall per annum. This was accompanied by a national annual increased risk of negative appendectomy, complication, reintervention, and readmission (adjusted odds ratio: 1.02, 1.03, 1.04, and 1.06, respectively). Children who had appendectomies in DGHs had 28% more negative appendectomies, 11% more complications, and 11% more readmissions than those in SPCs. Postoperative length of stay was double in SPCs compared with DGHs (median, 4 vs 2 days).
  
  
  CONCLUSIONS
  Major reductions in the number of pediatric emergency appendectomies in England over the past decade were associated with an overall increase in adverse surgical outcomes. Children operated in DGHs have more reinterventions, complications, and negative appendectomy rates than those operated in SPCs.
authors.affiliation: *Department of Paediatric and Neonatal Surgery, St George's Healthcare NHS Trust and University of London, London, UK †Department of Primary Care and Public Health, Imperial College London, London, UK ‡Kinderchirurgische Klinik und Poliklinik, Dr. von Haunersches Kinderspital, Munich, Germany §Department of Paediatric Infectious Disease, St George's Healthcare NHS Trust and University of London, London, UK.
authors.forename: Stefano
authors.initials: S
authors.lastname: Giuliani
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Cecil
authors.forename: Nadja
authors.initials: N
authors.lastname: Apelt
authors.forename: Michael
authors.initials: M
authors.lastname: Sharland
authors.forename: Sonia
authors.initials: S
authors.lastname: Saxena
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004638:Emergency Treatment / Q000706:statistics & numerical data; D004739:England; D005260:Female; D006767:Hospitals, District; D006769:Hospitals, General; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013531:Surgicenters; D013997:Time Factors; D016896:Treatment Outcome