Appendiceal inflammation affects the length of stay following appendicectomy amongst children: a myth or reality?
BACKGROUND The length of hospital stay following appendicectomy in children at Christchurch Hospital has decreased in recent years. The aim of the present study was to identify those factors that contributed to this change. METHODS A retrospective review of children admitted to Christchurch Hospital between 1994 and 1998 inclusive who underwent appendicectomy for suspected appendicitis was conducted. Data recorded included standard demographic information, symptom duration, operative details, analgesia, antibiotics, pathology, complications and postoperative length of stay (LOS). RESULTS Postoperative LOS decreased significantly during the period reviewed across all degrees of appendiceal inflammation, from a mean of 70.5 to 50.1 h. The main determinant of postoperative hospital stay was the severity of the appendiceal inflammatory process. Other factors that influenced LOS included surgical approach (open vs. laparoscopic), use of intra-operative local anaesthesia, type and mode of postoperative analgesia, and age of the child. Longer duration of antibiotic use and symptom duration of greater than 24 h were associated with a longer LOS, primarily as a reflection of the severity of inflammation of the appendix. Factors that appeared to have little or no influence included gender and the experience of the surgeon. CONCLUSION The severity of the inflammatory process appeared to be the main determinant of postoperative hospital LOS; advanced appendicitis with abscess formation or peritonitis was associated with the longest LOS, irrespective of the surgical approach, although the LOS after appendicectomy was reduced by a laparoscopic approach. Intra-operative local anaesthesia during open appendicectomy reduced hospital stay, probably because it reduced the need for postoperative narcotics. Early diagnosis (< 24 h) was associated with a shorter postoperative LOS for acutely inflamed appendices.