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Clinical Tool to Predict Prolonged Hospital Stay in Pediatric Patients with Appendicitis
Vol. 225, No. 4S2, October 2017
95% CI 0.03-0.08) and outpatient (OR 0.4, 95% CI 0.26-0.62) circumcision had significantly lower risks of immediate complications (all p<0.001). CONCLUSIONS: The complication rate for male circumcision is 2.3% and is higher than previously reported. The majority of these patients require a second operation. Clinicians should include a discussion of these risks when counselling parents about circumcision. Clinical Tool to Predict Prolonged Hospital Stay in Pediatric Patients with Appendicitis Faidah O Badru, MD, Yana Puckett, MD, MPH, Nicholas M Piening, Easle Chang, Grace Spinner, Jose Greenspon, MD, Colleen Fitzpatrick, Gustavo A Villalona, MD, Kaveer K Chatoorgoon, MD, FACS Cardinal Glennon Children’s Hospital, St Louis, MO INTRODUCTION: Children with appendicitis have a variable length of stay (LOS). LOS prediction allows for better parental counseling. The aim of this study is to use clinical variables to predict LOS in children with appendicitis. METHODS: Patients diagnosed with appendicitis between 2010 and 2015 were retrospectively reviewed. Variables abstracted included temperature, white blood cell count, duration of symptoms. Pearson’s chi square analysis was performed on categorical data and student’s t-test on continuous data. Prospective clinical score validation was then performed using an inpatient retrospective cohort analysis of the subsequent 6 months. RESULTS: A total of 949 patients were treated for appendicitis over the study period. Average age was 11.4 years and 60.7% were male. Thirty-four percent had perforated appendicitis and 84% underwent appendectomy on presentation. Median length of stay (LOS) was 2 days. Using regression analysis, temperature >101 F (odds ratio [OR] ¼ 3.46), tachycardia (OR ¼ 2.83), nasogastric tube (OR ¼ 2.70), and anorexia (OR ¼ 5.01) at 48 hours after admission predicted a LOS > 5 days. Patients with all 4 factors had a 96% probability of LOS > 5 days. Six month data validation of the scoring system showed an accuracy of 85%. CONCLUSIONS: At 48 hours, this simple clinical score can accurately predict prolonged LOS in children with appendicitis. This information allows for better counseling and education of patients and their families regarding their disease course.
Home Antibiotics for Perforated Appendicitis: Friend or Foe of Antibiotic Stewardship? Kathryn T Anderson, MD, MPH, Marisa A Bartz-Kurycki, MD, Galit Holzmann-Pazgal, MD, Akemi L Kawaguchi, MD, FACS, Mary T Austin, MD, MPH, Lillian S Kao, MD, FACS, Kevin P Lally, MD, FACS, KuoJen Tsao, MD, FACS McGovern Medical School, Houston, TX INTRODUCTION: Advocacy for antibiotic stewardship requires examination of effectiveness. The role of home discharge antibiotics
Scientific Poster Presentations: 2017 Clinical Congress
e135
in children after perforated appendicitis, including route of administration, is unclear. This study evaluates the outcomes of perforated appendicitis patients being discharged with or without home antibiotics. METHODS: The 2015 National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database was queried for patients with perforated appendicitis. Incidental/interval appendectomies were excluded. Home antibiotics were prescribed oral (PO), intravenous (IV), or not prescribed. Descriptive statistics, analysis of variance, multivariate logistic regression, chi square, and student’s t-test were used for analysis. RESULTS: A total of 1,778 patients underwent appendectomy for perforated appendicitis. The majority were discharged with antibiotics (no antibiotics 40.5%, PO 56.0%, IV 3.5%). Patients discharged with antibiotics had a higher pre-operative leukocytosis, longer procedures, higher incidence of sepsis, and longer length of stay than the no antibiotic group (all p<0.01) suggesting greater severity illness. However, after adjusting for demographics, preoperative characteristics, disease severity, and surgical approach, the home antibiotic group had more post-discharge emergency department visits, readmissions, reoperations, and intra-abdominal abscesses. The odds of any post-discharge complication was 1.4 (95% CI 1.1-1.8) for those discharged with antibiotics. More so, stratifying for route of administration, IV antibiotic patients had more post-discharge complications (odds ratio [OR] 1.7, 95% CI 0.99-3.0) than the PO group. CONCLUSIONS: Pediatric perforated appendicitis patients discharged with antibiotics after appendectomy had worse outcomes than those without antibiotics. With more than half the patients discharged with antibiotics, NSQIP-P data suggests that there is no benefit in routine prescription of antibiotics for perforated appendicitis at discharge. Impact of Lymph Node Ratio on Survival of Wilms Tumor: A National Cancer Database Analysis Omar Picado, MD, Punam P Parikh, MD, Diana M Lopategui, MD, Krishnamurti Rao, MD, MPH, Jun Tashiro, MD, MPH, Juan E Sola, MD, FACS, Eduardo A Perez, MD, FACS University of Miami, Miami, FL INTRODUCTION: Positive lymph node status in Wilms’ tumor (WT) is associated with decreased survival, yet the impact of positive lymph node ratio (LNR) on survival stands unclear. We assessed LNR as a predictor of survival in children with Wilms tumor. METHODS: Data from the National Cancer Database (2004 to 2013) were analyzed. LNR of patients with at least 3 nodes examined were calculated. The association between LNR and survival was assessed using Kaplan-Meier and Cox regression. RESULTS: We identified 1576 children with WT; 54% were female, 64% white non-Hispanic, and 95% insured. Median age at
95% CI 0.03-0.08) and outpatient (OR 0.4, 95% CI 0.26-0.62) circumcision had significantly lower risks of immediate complications (all p<0.001). CONCLUSIONS: The complication rate for male circumcision is 2.3% and is higher than previously reported. The majority of these patients require a second operation. Clinicians should include a discussion of these risks when counselling parents about circumcision. Clinical Tool to Predict Prolonged Hospital Stay in Pediatric Patients with Appendicitis Faidah O Badru, MD, Yana Puckett, MD, MPH, Nicholas M Piening, Easle Chang, Grace Spinner, Jose Greenspon, MD, Colleen Fitzpatrick, Gustavo A Villalona, MD, Kaveer K Chatoorgoon, MD, FACS Cardinal Glennon Children’s Hospital, St Louis, MO INTRODUCTION: Children with appendicitis have a variable length of stay (LOS). LOS prediction allows for better parental counseling. The aim of this study is to use clinical variables to predict LOS in children with appendicitis. METHODS: Patients diagnosed with appendicitis between 2010 and 2015 were retrospectively reviewed. Variables abstracted included temperature, white blood cell count, duration of symptoms. Pearson’s chi square analysis was performed on categorical data and student’s t-test on continuous data. Prospective clinical score validation was then performed using an inpatient retrospective cohort analysis of the subsequent 6 months. RESULTS: A total of 949 patients were treated for appendicitis over the study period. Average age was 11.4 years and 60.7% were male. Thirty-four percent had perforated appendicitis and 84% underwent appendectomy on presentation. Median length of stay (LOS) was 2 days. Using regression analysis, temperature >101 F (odds ratio [OR] ¼ 3.46), tachycardia (OR ¼ 2.83), nasogastric tube (OR ¼ 2.70), and anorexia (OR ¼ 5.01) at 48 hours after admission predicted a LOS > 5 days. Patients with all 4 factors had a 96% probability of LOS > 5 days. Six month data validation of the scoring system showed an accuracy of 85%. CONCLUSIONS: At 48 hours, this simple clinical score can accurately predict prolonged LOS in children with appendicitis. This information allows for better counseling and education of patients and their families regarding their disease course.
Home Antibiotics for Perforated Appendicitis: Friend or Foe of Antibiotic Stewardship? Kathryn T Anderson, MD, MPH, Marisa A Bartz-Kurycki, MD, Galit Holzmann-Pazgal, MD, Akemi L Kawaguchi, MD, FACS, Mary T Austin, MD, MPH, Lillian S Kao, MD, FACS, Kevin P Lally, MD, FACS, KuoJen Tsao, MD, FACS McGovern Medical School, Houston, TX INTRODUCTION: Advocacy for antibiotic stewardship requires examination of effectiveness. The role of home discharge antibiotics
Scientific Poster Presentations: 2017 Clinical Congress
e135
in children after perforated appendicitis, including route of administration, is unclear. This study evaluates the outcomes of perforated appendicitis patients being discharged with or without home antibiotics. METHODS: The 2015 National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database was queried for patients with perforated appendicitis. Incidental/interval appendectomies were excluded. Home antibiotics were prescribed oral (PO), intravenous (IV), or not prescribed. Descriptive statistics, analysis of variance, multivariate logistic regression, chi square, and student’s t-test were used for analysis. RESULTS: A total of 1,778 patients underwent appendectomy for perforated appendicitis. The majority were discharged with antibiotics (no antibiotics 40.5%, PO 56.0%, IV 3.5%). Patients discharged with antibiotics had a higher pre-operative leukocytosis, longer procedures, higher incidence of sepsis, and longer length of stay than the no antibiotic group (all p<0.01) suggesting greater severity illness. However, after adjusting for demographics, preoperative characteristics, disease severity, and surgical approach, the home antibiotic group had more post-discharge emergency department visits, readmissions, reoperations, and intra-abdominal abscesses. The odds of any post-discharge complication was 1.4 (95% CI 1.1-1.8) for those discharged with antibiotics. More so, stratifying for route of administration, IV antibiotic patients had more post-discharge complications (odds ratio [OR] 1.7, 95% CI 0.99-3.0) than the PO group. CONCLUSIONS: Pediatric perforated appendicitis patients discharged with antibiotics after appendectomy had worse outcomes than those without antibiotics. With more than half the patients discharged with antibiotics, NSQIP-P data suggests that there is no benefit in routine prescription of antibiotics for perforated appendicitis at discharge. Impact of Lymph Node Ratio on Survival of Wilms Tumor: A National Cancer Database Analysis Omar Picado, MD, Punam P Parikh, MD, Diana M Lopategui, MD, Krishnamurti Rao, MD, MPH, Jun Tashiro, MD, MPH, Juan E Sola, MD, FACS, Eduardo A Perez, MD, FACS University of Miami, Miami, FL INTRODUCTION: Positive lymph node status in Wilms’ tumor (WT) is associated with decreased survival, yet the impact of positive lymph node ratio (LNR) on survival stands unclear. We assessed LNR as a predictor of survival in children with Wilms tumor. METHODS: Data from the National Cancer Database (2004 to 2013) were analyzed. LNR of patients with at least 3 nodes examined were calculated. The association between LNR and survival was assessed using Kaplan-Meier and Cox regression. RESULTS: We identified 1576 children with WT; 54% were female, 64% white non-Hispanic, and 95% insured. Median age at