Document Detail


The association of elevated percent bands on admission with failure and complications of interval appendectomy.
MedLine Citation:
PMID:  11150458     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/PURPOSE: The routine use of interval appendectomy for the treatment of perforated appendicitis, with or without abscess, remains controversial. The purpose of this study is to confirm the efficacy of this approach and to identify factors associated with failures and complications. METHODS: All patients (n = 101) with their clinical diagnosis of perforated appendicitis confirmed with imaging were treated prospectively with fluids and intravenous antibiotics (clindamycin, ceftazidime) and were discharged home on oral fluids and analgesics regardless of fever. Intravenous antibiotics were continued at home until the patients were afebrile for 48 hours, and their white blood cell and differential counts were normal. Patients were readmitted at 8 to 12 weeks for an interval appendectomy. Failure to improve by 72 hours of antibiotic therapy mandated an early appendectomy. P values were determined by chi(2) analysis and Student's t test. RESULTS: The 79 patients (78%) successfully treated with interval appendectomy had an overall 6.3% complication rate, and total hospitalization averaged 5.2 days. The treatment in 21 of 22 patients (22%) requiring early appendectomy failed because of a clinical picture suggesting small bowel obstruction. The patients with the failed procedures had a complication rate of 50% and were hospitalized an average of 12.8 days. The overall complication rate for the 101 patients was 15.8%, and the overall total hospitalization was 6.9 days. Patients requiring early appendectomy had a more frequent finding resembling a small bowel obstruction on their initial x-ray (50% v 13%, P = .004) and a higher percent band count on their initial differential blood cell count (22.6% v 7.6%, P<0.0001) than did those successfully treated with interval appendectomy. An initial band count <15% was predictive of an uncomplicated course (84% positive predictive value). CONCLUSIONS: Interval appendectomy without complications is successful in the majority of patients with perforated appendicitis. An elevated initial band count > or =15% is associated with an increased likelihood of failure and complications.
Authors:
K A Kogut; M L Blakely; K P Schropp; W Deselle; S D Hixson; A M Davidoff; T E Lobe
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  36     ISSN:  0022-3468     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2001 Jan 
Date Detail:
Created Date:  2001-03-06     Completed Date:  2001-05-31     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  165-8     Citation Subset:  IM    
Affiliation:
University of Tennessee, LeBonheur Children's Medical Center, Memphis, TN 38105, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Anti-Bacterial Agents / therapeutic use
Appendectomy / methods*
Appendicitis / blood,  complications,  surgery*
Chi-Square Distribution
Child
Child, Preschool
Female
Fluid Therapy
Humans
Infant
Intestinal Perforation / blood,  etiology,  surgery*
Length of Stay / statistics & numerical data
Leukocyte Count*
Male
Postoperative Complications
Predictive Value of Tests
Prospective Studies
Treatment Failure
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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