title: Evaluating the effect of time process measures on appendectomy clinical outcomes.
abstract: BACKGROUND
  With varied reports on the impact of time to appendectomy on clinical outcomes, we examined the effects of pre-operative delays in pediatric acute appendicitis.
  
  
  METHODS
  Children with acute appendicitis (January 2013-June 2014) were identified from a prospective database. Univariate analyses compared time metrics, patient characteristics, and disease severity with postoperative complications (POC) and organ space surgical site infection (OSSI), and multivariate logistic regression determined predictors of POC and OSSI.
  
  
  RESULTS
  1211 patients underwent appendectomy. Median age was 10.4years (IQR 7.8-13years). 537 patients (45%) had complex appendicitis. Overall, POC was 11% (n=133), and OSSI was 9% (n=105). Neither time from presentation to appendectomy nor diagnosis to appendectomy increased POCs. On univariate analyses, operative time (OT) was longer in patients with POC (57min (IQR 49-75) vs. 46min (IQR 36-57), p<0.001 and OSSI (60min (IQR 51-80) vs. 46min (IQR 37-57), p<0.001. However, after adjusting for confounding factors, disease severity remained the most significant predictor of POC (OR 6.5, 95% CI 2.79-15.23) and OSSI (OR 76.6, 95% CI 7.87-745.65).
  
  
  CONCLUSIONS
  Pre-operative delays were not associated with increased POC or OSSI. The strongest predictor of POC or OSSI was disease severity, for which operative time may represent a surrogate.
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Paulette I
authors.initials: PI
authors.lastname: Abbas
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
authors.forename: Michelle
authors.initials: M
authors.lastname: Peterson
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
authors.forename: Lindsay J
authors.initials: LJ
authors.lastname: Stephens
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: J Ruben
authors.initials: JR
authors.lastname: Rodriguez
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Lee
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Brandt
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX. Electronic address: melopez@texaschildrens.org.
authors.forename: Monica E
authors.initials: ME
authors.lastname: Lopez
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001062:Appendectomy / Q000009:adverse effects; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis; D012189:Retrospective Studies; D013997:Time Factors
keywords: Appendicitis; Delayed appendectomy; Pediatric surgery; Surgical site infections; Time metrics