title: Therapeutic effectiveness of percutaneous drainage and factors for performing an interval appendectomy in pediatric appendiceal abscess.
abstract: BACKGROUND
  In this study, we studied the therapeutic effectiveness of percutaneous drainage with antibiotics and the need for an interval appendectomy for treating appendiceal abscess in children with a research-oriented dataset released by the Bureau of National Health Insurance in Taiwan through the Collaboration Center for Health Information Application (CCHIA).
  
  
  METHODS
  We identified 1225 patients under 18 years of age who had non-surgical treatment for an appendiceal abscess between 2007 and 2012 in a Taiwan CCHIA dataset. The treatment included percutaneous drainage with antibiotics or antibiotics alone. We also analyzed data of patient's baseline characteristics, outcomes of percutaneous drainage, and indicating factors for performing an interval appendectomy.
  
  
  RESULTS
  Totally, 6190 children had an appendiceal abscess, an 1225 patients received non-operative treatment. Of 1225 patients, 150 patients received treatment with percutaneous drainage and antibiotics, 78 had recurrent appendicitis, 185 went on to receive an interval appendectomy, and 10 had postoperative complications after the interval appendectomy. We found that patients treated with percutaneous drainage and antibiotics had a significantly lower rate of recurrent appendicitis (p < 0.05), a significantly smaller chance of receiving an interval appendectomy (p < 0.05), and significantly fewer postoperative complications after the interval appendectomy (p < 0.05) than those without percutaneous drainage treatment. Older children (13 ~ 18 years) patients were found to have a significantly smaller need to receive an interval appendectomy than those who were ≤ 6 years of age (odd ratio (OR) = 2.071, 95 % confidence interval (CI) = 1.34-3.19, p < 0.01), and those who were 7 ~ 12 years old (OR = 1.662, 95 % CI = 1.15-2.41, p < 0.01). In addition, those treated with percutaneous drainage were significantly less indicated to receive an interval appendectomy later (OR = 2.249, 95 % CI = 1.19 ~ 4.26, p < 0.05). In addition, those with recurrent appendicitis had a significantly increased incidence of receiving an interval appendectomy later (OR = 3.231, 95 % CI = 1.95 ~ 5.35, p < 0.001).
  
  
  CONCLUSIONS
  In this study, we used nationwide data to demonstrate therapeutic effectiveness of percutaneous drainage and antibiotics was more beneficial than only antibiotics in treating patients with an appendiceal abscess. We also found three factors that were significantly associated with receiving an interval appendectomy: recurrent appendicitis, being aged ≤ 13 years, and treatment with antibiotics only.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Wan Fang Medical Center, Taipei Medical University, 111 Xinglong Rd., Sect. 3, 11696, Taipei, Taiwan. 102145@w.tmu.edu.tw.|Division of Pediatric Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, No.250, Wuxing St, Taipei, 11031, Taiwan. 102145@w.tmu.edu.tw.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Luo
authors.affiliation: Biostatistics Center, Taipei Medical University, Taipei, Taiwan.
authors.forename: Kuang-Fu
authors.initials: KF
authors.lastname: Cheng
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Wan Fang Medical Center, Taipei Medical University, 111 Xinglong Rd., Sect. 3, 11696, Taipei, Taiwan.
authors.forename: Chen-Sheng
authors.initials: CS
authors.lastname: Huang
authors.affiliation: Department of Traumatology, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan.
authors.forename: Hung-Chieh
authors.initials: HC
authors.lastname: Lo
authors.affiliation: Department of Traumatology, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan.
authors.forename: Sheng-Mao
authors.initials: SM
authors.lastname: Wu
authors.affiliation: Department of Acute Care Surgery and Traumatology, Taipei Medical University, Taipei, Taiwan.
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Huang
authors.affiliation: Biostatistics Center, Taipei Medical University, Taipei, Taiwan.
authors.forename: Wen-Kuei
authors.initials: WK
authors.lastname: Chien
authors.affiliation: Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, 252 Wu-Xing Street, Taipei, 110, Taiwan. rayjchen@tmu.edu.tw.|Division of Pediatric Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, No.250, Wuxing St, Taipei, 11031, Taiwan. rayjchen@tmu.edu.tw.
authors.forename: Ray-Jade
authors.initials: RJ
authors.lastname: Chen
mesh_terms: D000038:Abscess / Q000188:drug therapy / Q000601:surgery*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy; D001064:Appendicitis / Q000188:drug therapy / Q000601:surgery*; D002648:Child; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Appendiceal abscess; Interval appendectomy; Percutaneous drainage