title: Predicting Postoperative Complications After Pediatric Perforated Appendicitis.
abstract: OBJECTIVE
  Assessment of risk factors for postoperative complications following surgical treatment of pediatric perforated appendicitis (PA) is necessary to identify those patients in need of closer monitoring. In this study, we have investigated the impact of different risk factors on the occurrence of complications after an appendectomy in children with PA.
  
  
  METHODS
  The study was a retrospective, single-centre analysis of all pediatric PA conducted over a 10-year period. Preoperative clinical and laboratory results, intraoperative findings, and postoperative complications were analyzed. Risk factors were defined and a risk score was determined for postoperative complications and reinterventions.
  
  
  RESULTS
  Surgical treatment for appendicitis was performed in 840 pediatric patients during the observation period. 163 of the included patients were diagnosed with PA (mean age 8.9 ± 3.6 years). 19 (11.7%) patients developed postoperative complications, 17 (10.4%) of which required complication-related intervention. We identified five predictors of postoperative complications: the C-related protein value at admission, purulent peritonitis, open appendectomy (primary, secondary, or converted), placement of an abdominal drain, and administration of antibiotics not compliant to results from the subsequent antibiogram. The determined risk score was significantly higher in the complication group (p < .0001) and reintervention group (p < .001).
  
  
  CONCLUSIONS
  Postoperative complications following pediatric PA can be predicted using specific preoperative, intraoperative, and postoperative risk factors. In the high-risk group, an active prevention, detection, and intervention of any occurring complication is necessary and we present a new specific pediatric risk score to define patients at risk for complications.
authors.affiliation: a Division of Pediatric Surgery, Department of General , Visceral and Transplantation Surgery.
authors.forename: G
authors.initials: G
authors.lastname: Frongia
authors.affiliation: b Department of General , Visceral and Transplantation Surgery.
authors.forename: A
authors.initials: A
authors.lastname: Mehrabi
authors.affiliation: a Division of Pediatric Surgery, Department of General , Visceral and Transplantation Surgery.
authors.forename: L
authors.initials: L
authors.lastname: Ziebell
authors.affiliation: c Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology , University Hospital of Heidelberg , Heidelberg , Germany.
authors.forename: J P
authors.initials: JP
authors.lastname: Schenk
authors.affiliation: a Division of Pediatric Surgery, Department of General , Visceral and Transplantation Surgery.
authors.forename: P
authors.initials: P
authors.lastname: Günther
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy / Q000009:adverse effects* / Q000379:methods; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D010538:Peritonitis / Q000150:complications; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
keywords: Outocome; children; complications; pediatric; perforated appendicitis; prevention; risk factors; risk score