Nationwide study of appendicitis in children

E Omling, M Salö, S Saluja, S Bergbrant, L Olsson, A Persson, J Björk, L Hagander, E Omling, M Salö, S Saluja, S Bergbrant, L Olsson, A Persson, J Björk, L Hagander

Abstract

Background: Paediatric surgical care is increasingly being centralized away from low-volume centres, and prehospital delay is considered a risk factor for more complicated appendicitis. The aim of this study was to determine the incidence of paediatric appendicitis in Sweden, and to assess whether distance to the hospital was a risk factor for complicated disease.

Methods: A nationwide cohort study of all paediatric appendicitis cases in Sweden, 2001-2014, was undertaken, including incidence of disease in different population strata, with trends over time. The risk of complicated disease was determined by regression methods, with travel time as the primary exposure and individual-level socioeconomic determinants as independent variables.

Results: Some 38 939 children with appendicitis were identified. Of these, 16·8 per cent had complicated disease, and the estimated risk of paediatric appendicitis by age 18 years was 2·5 per cent. Travel time to the treating hospital was not associated with complicated disease (adjusted odds ratio (OR) 1·00 (95 per cent c.i. 0·96 to 1·05) per 30-min increase; P = 0·934). Level of education (P = 0·177) and family income (P = 0·120) were not independently associated with increased risk of complicated disease. Parental unemployment (adjusted OR 1·17, 95 per cent c.i. 1·05 to 1·32; P = 0·006) and having parents born outside Sweden (1 parent born in Sweden: adjusted OR 1·12, 1·01 to 1·25; both parents born outside Sweden: adjusted OR 1·32, 1·18 to 1·47; P < 0·001) were associated with an increased risk of complicated appendicitis.

Conclusion: Every sixth child diagnosed with appendicitis in Sweden has a more complicated course of disease. Geographical distance to the surgical facility was not a risk factor for complicated appendicitis.

© 2019 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

Figures

Figure 1
Figure 1
Incidence of appendicitis by age and sex, and complicated and uncomplicated appendicitis by age, among Swedish children, 2001–2014 a Incidence of appendicitis by age and sex. The adjusted incidence rate ratio, obtained from multivariable Poisson regression analysis, increased by 12·8 (95 per cent c.i. 12·6 to 13·0) per cent per added year of age (P < 0·001). b Incidence of complicated and uncomplicated appendicitis by age, and percentage of complicated appendicitis.
Figure 2
Figure 2
Risk of complicated appendicitis by travel time to treating hospital and by each socioeconomic determinant *Values in parentheses are percentages; odds ratios are shown with 95 per cent confidence intervals. Regression analyses were adjusted for age, year and the ICD‐10 revision, and stratified by county of treatment.
Figure 3
Figure 3
Multivariable effect estimates of travel time to treating hospital on risk of complicated appendicitis Odds ratios are shown with 95 per cent confidence intervals. Regression analyses were adjusted for socioeconomic determinants, age, year and the ICD‐10 revision, and stratified by county of treatment. *Cases with an estimated travel time of 240 minutes or more were considered outliers and excluded from the multivariable analysis.

References

    1. Salazar JH, Goldstein SD, Yang J, Gause C, Swarup A, Hsiung GE et al Regionalization of pediatric surgery: trends already underway. Ann Surg 2016; 263: 1062–1066.
    1. França UL, McManus ML. Trends in regionalization of hospital care for common pediatric conditions. Pediatrics 2018; 141: e20171940.
    1. França UL, McManus ML. Outcomes of hospital transfers for pediatric abdominal pain and appendicitis. JAMA Netw Open 2018; 1: e183249.
    1. Braveman P, Schaaf VM, Egerter S, Bennett T, Schecter W. Insurance‐related differences in the risk of ruptured appendix. N Engl J Med 1994; 331: 444–449.
    1. Gadomski A, Jenkins P. Ruptured appendicitis among children as an indicator of access to care. Health Serv Res 2001; 36: 129–142.
    1. O'Toole SJ, Karamanoukian HL, Allen JE, Caty MG, O'Toole D, Azizkhan RG et al Insurance‐related differences in the presentation of pediatric appendicitis. J Pediatr Surg 1996; 31: 1032–1034.
    1. Ponsky TA, Huang ZJ, Kittle K, Eichelberger MR, Gilbert JC, Brody F et al Hospital‐ and patient‐level characteristics and the risk of appendiceal rupture and negative appendectomy in children. JAMA 2004; 292: 1977–1982.
    1. Scott JW, Rose JA, Tsai TC, Zogg CK, Shrime MG, Sommers BD et al Impact of ACA insurance coverage expansion on perforated appendix rates among young adults. Med Care 2016; 54: 818–826.
    1. Baxter KJ, Nguyen HTMH, Wulkan ML, Raval MV. Association of health care utilization with rates of perforated appendicitis in children 18 years or younger. JAMA Surg 2018; 153: 544–550.
    1. Terlinder J, Andersson RE. Incidence of appendicitis according to region of origin in first‐ and second‐generation immigrants and adoptees in Sweden. A cohort follow‐up study. Scand J Gastroenterol 2016; 51: 111–120.
    1. Salö M, Gudjonsdottir J, Omling E, Hagander L, Stenström P. Association of IgE‐mediated allergy with risk of complicated appendicitis in a pediatric population. JAMA Pediatr 2018; 172: 943–948.
    1. Swidsinski A, Dörffel Y, Loening‐Baucke V, Theissig F, Rückert JC, Ismail M et al Acute appendicitis is characterised by local invasion with Fusobacterium nucleatum/necrophorum . Gut 2011; 60: 34–40.
    1. Temple CL, Huchcroft SA, Temple WJ. The natural history of appendicitis in adults. A prospective study. Ann Surg 1995; 221: 278–281.
    1. Penfold RB, Chisolm DJ, Nwomeh BC, Kelleher KJ. Geographic disparities in the risk of perforated appendicitis among children in Ohio: 2001–2003. Int J Health Geogr 2008; 7: 56.
    1. Bratu I, Martens PJ, Leslie WD, Dik N, Chateau D, Katz A. Pediatric appendicitis rupture rate: disparities despite universal health care. J Pediatr Surg 2008; 43: 1964–1969.
    1. Statistiska centralbyrån (Statistics Sweden) . Population by Region, Marital Status, Age and Sex. Year 1968–2014 [accessed 23 Ocober 2018].
    1. Ng‐Kamstra JS, Raykar NP, Lin Y, Mukhopadhyay S, Saluja S, Yorlets R et al. Data for the Sustainable Development of Surgical Systems: a Global Collaboration; 2015. [accessed 13 May 2019].
    1. Anell A. The public–private pendulum – patient choice and equity in Sweden. N Engl J Med 2015; 372: 1–4.
    1. Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C et al External review and validation of the Swedish national inpatient register. BMC Public Health 2011; 11: 1–16.
    1. Statistiska centralbyrån (Statistics Sweden) . Multi‐Generation Register [accessed 5 January 2019].
    1. Statistiska centralbyrån (Statistics Sweden) . Labour and Taxation Register [accessed 23 October 2019].
    1. Statistiska centralbyrån (Statistics Sweden) . Longitudinal Integration Database for Health Insurance and Labour Market Studies (LISA) [accessed 5 January 2019].
    1. Trafikverket . Road Data Overview. Version 2.0; 2015. [accessed 13 May 2019].
    1. WHO . ICD10 – Version: 2016 [accessed 13 May 2019].
    1. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies; 2007. [accessed 13 May 2019].
    1. Environmental Systems Research Institute . ArcGIS 10.3.1. Environmental Systems Research Institute: Redlands, 2015.
    1. Nordic Medico‐Statistical Committee (NOMESCO) . NOMESCO Classification of Surgical Procedures (NCSP), Version 1.16. NOMESCO: Copenhagen, 2010.
    1. França UL, McManus ML. Availability of definitive hospital care for children. JAMA Pediatr 2017; 171: e171096.
    1. Kim M, Kim SJ, Cho HJ. Effect of surgical timing and outcomes for appendicitis severity. Ann Surg Treat Res 2016; 91: 85–89.
    1. Smink DS, Fishman SJ, Kleinman K, Finkelstein JA. Effects of race, insurance status, and hospital volume on perforated appendicitis in children. Pediatrics 2005; 115: 920–925.
    1. Lin KB, Lai KR, Yang NP, Chan CL, Liu YH, Pan RH et al Epidemiology and socioeconomic features of appendicitis in Taiwan: a 12‐year population‐based study. World J Emerg Surg 2015; 10: 1–13.
    1. Hernandez MC, Finnesgaard E, Aho JM, Kong VY, Bruce JL, Polites SF et al Appendicitis: rural patient status is associated with increased duration of prehospital symptoms and worse outcomes in high‐ and low‐middle‐income countries. World J Surg 2018; 42: 1573–1580.
    1. Lee SL, Shekherdimian S, Chiu VY. Effect of race and socioeconomic status in the treatment of appendicitis in patients with equal health care access. Arch Surg 2011; 146: 156–161.
    1. Andersson R, Hugander A, Thulin A, Nyström PO, Olaison G. Indications for operation in suspected appendicitis and incidence of perforation. BMJ 1994; 308: 107–110.
    1. Andersson RE. Does delay of diagnosis and treatment in appendicitis cause perforation? World J Surg 2016; 40: 1315–1317.
    1. Aarabi S, Sidhwa F, Riehle KJ, Chen Q, Mooney DP. Pediatric appendicitis in New England: epidemiology and outcomes. J Pediatr Surg 2011; 46: 1106–1114.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren