Outcomes of Pediatric Patients with Perforated Appendicitis After Implementation of a Delayed Post-operative Imaging Protocol

Authors:
Jill Knepprath, Eiichi Miyaska

Body of Abstract:
Background:

Post-operative management of pediatric perforated appendicitis is highly variable with no clear guidelines for the timing of post-operative imaging. Some studies suggest that delayed imaging may decrease both unnecessary radiation and invasive procedures, while other authors found that delayed imaging was associated with prolonged hospital stays. In this study we investigated changes in outcomes at a single institution after the implementation of a protocol recommending imaging on post-operative day (POD) 7.

Methods:

This was a single institution retrospective chart review of pediatric patients who underwent an appendectomy for perforated acute appendicitis between January 2021 and June 2025. A modification to the protocol occurred in January 2024, with post-operative imaging recommendations changing from POD 5 to POD 7. No other changes to the protocol were made between January 2021 and June 2025. Patients were divided into two cohorts, Group 1 included patients before protocol modifications (January 2021-December 2023) and Group 2 included patients after protocol modifications (January 2024-June 2025). Categorical data between both groups were compared using the Chi-Square test and medians were compared using the Mann-Whitney U test.

Results:

There were 105 patients in Group 1 and 49 patients in Group 2. There was no difference in length of stay between groups. There was no difference in imaging use (CT or ultrasound) between perforated patients in either group. Group 2 perforated patients had imaging done on a later POD than Group 1. Neither group was more likely to alter their treatment plan based on imaging. There was no difference in post-operative interventions. There was no significant difference in overall complications or in post-operative abscess formation. However, Group 2 perforated patients were more likely to be readmitted (10.2% vs 5.7%, p= 0.0054) or have an emergency room visit after discharge (18.4% vs 5.7%, p= 0.0136). (Table) Of patients with emergency room visits in both groups, the proportion of patients with imaging during their index admission was no different.

Conclusions:

This study suggests that later imaging does not change length of stay, does not decrease imaging or interventions, and does not impact abscess rates. However, patients that undergo delayed imaging may be more likely to be readmitted or present to the emergency room after discharge.