title: Operative Findings Are a Better Predictor of Resource Utilization in Pediatric Appendicitis.
abstract: OBJECTIVE
  Post-operative management following appendectomy is dependent upon intraoperative assessment. We determined concordance between surgical and histopathologic diagnosis to better predict resource utilization in pediatric patients undergoing appendectomy.
  
  
  METHODS
  A retrospective analysis of 326 patients with operative appendicitis from July 2012 to July 2013 was performed. Based on operative findings, patients were classified as simple appendicitis (SA) or complex appendicitis (CA).
  
  
  RESULTS
  The SA group included 194 (59.5%) patients while the CA group included 132 (40.5%) patients. There were significant differences in WBC, CRP, operative time, length of stay, and 30-day complications. Seventy percent of patients with intra-operative findings of SA were found to have complex pathology while 10.6% with intra-operative findings of CA were found to have simple pathology. There is poor agreement between intra-operative findings and histopathologic findings (κ=0.173). Although 70% of patients with intra-operative findings of SA were labeled as complex pathology, 86% followed a fast track protocol (same day discharge) with a low complication rate (1.7%).
  
  
  CONCLUSIONS
  Pathology findings that overestimate the severity of disease correlate poorly with the post-operative outcomes for appendicitis. We conclude that operative findings are more predictive of clinical course than histopathologic results. This can have an impact on resource utilization planning.
authors.affiliation: Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA. Electronic address: sfarach1@jhmi.edu.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Farach
authors.affiliation: Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA. Electronic address: Paul.Danielson@jhmi.edu.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Danielson
authors.affiliation: Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA. Electronic address: nwalfor1@jhmi.edu.
authors.forename: N Elizabeth
authors.initials: NE
authors.lastname: Walford
authors.affiliation: Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA. Electronic address: rharmel1@jhmi.edu.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Harmel
authors.affiliation: Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA. Electronic address: Nicole.Chandler@jhmi.edu.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Chandler
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D055815:Young Adult
keywords: Appendectomy; Appendicitis; Histology; Pathology; Pediatric