Effect of physician specialty training on pediatric appendectomy outcomes: an NSQIP-P analysis
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In brief
In brief
This NSQIP-P database analysis compared outcomes of pediatric appendectomies performed by general surgeons versus pediatric surgeons between 2015-2020. The study found no significant differences in readmissions, complications, reoperations, or discharge destinations between the two specialties when procedures were performed at children's hospitals or facilities with pediatric wings.
- Pediatric and general surgeons achieve equivalent outcomes in pediatric appendectomy regarding complications, readmissions, and reoperations.
- General surgeons operated on slightly older children (mean 12.3 vs 11.2 years) but outcomes remained comparable across age groups.
- Surgeon specialty training does not significantly impact adverse events, reoperation rates, or discharge disposition in pediatric appendectomy.
- NSQIP-P data shows no difference in operative safety between pediatric and general surgeons performing appendectomies at pediatric facilities.
- Hospital setting with pediatric resources may be more critical than surgeon specialty for safe pediatric appendectomy outcomes.
Written by the GCMD Library team from the article.
Abstract
Purpose
Appendectomies are the most common abdominal emergency surgery in pediatric patients. Both pediatric and general surgeons are credentialed to perform this procedure, however pediatric surgeons are specialized in pediatrics. This study seeks to determine differences in pediatric appendectomy outcomes between general and pediatric surgeons.
Methods
Pediatric patients undergoing appendectomies between 2015 and 2020 were identified in the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. Multivariable logistic regression models examined association of surgeon specialty with readmission, postoperative complications, reoperation, non-home discharge destination, operative time, etc. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated.
Results
Average ages of pediatric patients undergoing appendectomy by pediatric and general surgeons were 11.2 (n = 68,638) and 12.3 (n = 3,986) years, respectively (p < .001). General surgeons were not more likely to have adverse outcomes [AOR: 1.00 (0.99–1.01), p = 0.57], readmissions [AOR: 0.995 (0.98–1.00), p = 0.11], reoperations [AOR: 1.00 (0.99–1.00), p = 0.54], or non-home discharges [AOR: 0.99 (0.99–1.00), p = 0.94].
Conclusions
Similar outcomes arise in pediatric appendectomies performed by general surgery at a children’s hospital or hospitals with a pediatric wing. Significant limitations to using the NSQIP-P database persist. Further research including hospitals contributing to both adult and pediatric databases can provide a clearer picture of post-surgical outcomes in appendectomies.