Does age affect the outcomes and management of pediatric appendicitis in Taiwan?

Background/Introduction: Despite advances in ultrasound and computed tomography, perforation rates in children ≤6 years of age have been reported to range from 54%-74% over the past three decades according to two previous reports. The comprehensive coverage offered by the Taiwan National Health Insurance program enabled us to effectively evaluate the effect of age on postoperative morbidity. Purpose(s)/Aim(s): To investigate whether age affected the outcomes and management of appendicitis in children in Taiwan. Methods: We used the Collaboration Center for Health Information Application database to identify 21,827 patients ≤18 years of age who had been hospitalized with a diagnosis of acute appendicitis between 2007 and 2012 in Taiwan. Study outcomes included postoperative morbidity, undergoing laparoscopic appendectomy (LA) or open appendectomy, and the length of hospitalization. Postoperative morbidity included the incidence of intra-abdominal abscesses (IAAs) and postoperative bowel obstructions (PBOs). Patients were divided into three age groups: ≤6 years, 7-12 years, and 13-18 years. Data for univariate associations were computed using a chi-square test. The odds ratios (ORs) and 95% confidence intervals (CIs) of IAA and PBO risk factors were derived from the multivariate logistic regression models. Results: Overall, an LA was used in only 41% of children, and the total IAA and PBO complication rates were 1.8% and 0.6%, respectively. The perforation rate was highest for patients ≤6 years old at 51% as compared with 32% of patients aged 7-12 years and 24% of those aged 13-18 years (p < 0.0001). An LA was least often performed in younger children [24% of patients aged ≤6 years, 37% of those aged 7-12 years, and 44% of those aged 13-18 years (p < 0.0001)]. In the multivariable analysis, the adjusted ORs for IAAs and PBOs for patients aged 7-12 years and 13-18 years who had a perforated appendicitis and underwent an LA were 0.66 (95% CI: 0.47-0.93; . p = 0.0182) and 0.51 (95% CI: 0.37-0.72; . p = 0.0001) and 0.49 (95% CI: 0.28-0.86; p = 0.0125) and 0.41 (95% CI: 0.23-0.71; p = 0.0014), respectively, as compared with those aged ≤6 years. Conclusion: Our study demonstrated that children in the youngest age group (≤6 years) had a high rate of appendix perforation and required fewer LAs. When LAs were performed on children in this age group to treat perforated appendicitis, IAA and PBO risks were higher than in other older age groups.