Paediatric appendicitis: increased disease severity and complication rates in rural children
| Autor: | Henry Witcomb Cahill, Brodie M Elliott, Christopher Harmston |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Perforation (oil well) Rural Health Severity of Illness Index 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Appendectomy Humans Surgical emergency Child Prospective cohort study Retrospective Studies business.industry Retrospective cohort study General Medicine Odds ratio Appendicitis medicine.disease 030220 oncology & carcinogenesis Cohort Female 030211 gastroenterology & hepatology Surgery business New Zealand Cohort study |
| Zdroj: | ANZ Journal of Surgery. 89:1126-1132 |
| ISSN: | 1445-2197 1445-1433 |
| Popis: | Background Appendicitis is the most common surgical emergency affecting children. Rurality has been shown to be a predictor of worse surgical outcomes in patients with acute appendicitis compared to urban residents. There are no previously published studies investigating this in Australasia. Methods A 10-year retrospective study of all patients aged ≤16 years who underwent an acute appendicectomy in Northland, New Zealand, was conducted. The cohort was identified by searching the hospital database for theatre events and admission diagnoses coded as appendicitis. Primary outcome of interest was the difference in the American Association for the Surgery of Trauma (AAST) anatomical severity grading of appendicitis and the Clavien-Dindo complication rate. The role of ethnicity was also examined. Results A total of 470 children underwent appendicectomy during this period. On multivariate analysis, increased AAST grade was twice as likely in rural patients (odds ratio 2.04). Post-operatively, rural patients had higher Clavien-Dindo complication grade (P = 0.001), longer median length of stay and increased rates of intra-abdominal collection (19% versus 4%; P = 0.018), 30-day readmission (19% versus 4%; P = 0.020) and perforation (27% versus 19%; P = 0.031). Māori children had increased perforation rates (28.9% versus 19.0%; P = 0.014) but ethnicity was not found to be independently associated with increasing AAST grade. Conclusion Accounting for ethnicity, socio-economic deprivation and age, we implicate rural patient status as being associated with increasing severity and complicated paediatric appendicitis. This work adds to the evolving description of inequities in rural health outcomes. Further prospective studies are needed to confirm these findings at a national level. |
| Databáze: | OpenAIRE |
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