Development and Implications of an Evidence-based and Public Health-relevant Definition of Complicated Appendicitis in Children

Multi-center study of 5,002 pediatric appendectomy cases identifies four intraoperative findings that independently predict complications and increased costs, providing an evidence-based framework for defining complicated appendicitis. Presence of visible perforation, diffuse exudate, abscess, or extraluminal fecalith each associated with 2-9x higher adverse event rates and significantly longer hospital stays.