Effect of peritoneal drainage on the prognosis following appendectomy in pediatric patients with appendicitis: a retrospective study based on appendicitis grade
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In brief
In brief
This retrospective study evaluates how peritoneal drainage type affects recovery and complications in pediatric appendectomy patients across five appendicitis severity grades. Results show no drainage correlates with faster recovery in mild cases, while active drainage reduces drain time and antibiotic duration in severe cases compared to passive drainage.
- Appendicitis grade predicts postoperative intra-abdominal abscess risk and length of hospitalization in pediatric patients.
- Grade I appendicitis: avoid peritoneal drainage—no drainage yields faster recovery and fewer complications than passive or active drainage.
- Grade ≥II appendicitis: active drainage reduces antibiotic duration and hospital stay compared to passive drainage.
- No drainage group had significantly lower wound infection and overall complication rates across all appendicitis grades.
- Active drainage allows earlier drain removal than passive drainage but may increase hospital stay in some higher-grade cases.
Written by the GCMD Library team from the article.
Abstract
Background
This study aimed to assess the impact of peritoneal drainage and its type on prognosis, encompassing postoperative recovery and complications, in pediatric patients (≤ 16 years old) following appendectomy based on the grade of appendicitis.
Methods
In this retrospective study, we analyzed pediatric patients (≤ 16 years old) with appendicitis who met the inclusion and exclusion criteria in our center from January 2017 to January 2024 and classified them into grade I–V based on the grade of appendicitis, with V representing the most serious cases. The patients were grouped according to drainage status and type. The main clinical outcomes included postoperative rehabilitation indexes such as time to resume a soft diet, time to remove the drain, duration of postoperative antibiotic use and length of hospitalization (LOH), as well as postoperative complications including intra-abdominal abscess (IAA), ileus and wound infection (WI), and readmission within 30 days after surgery.
Results
A total of 385 pediatric patients with appendicitis were included in the study and divided into No-drainage (ND) group (n = 74), Passive drainage (PD) group (n = 246) and Active drainage (AD) group (n = 65) according to drainage status and type. Compared to the other two groups, the ND group had a significantly shorter time to resume a soft diet, duration of postoperative antibiotic use and LOH, and these differences were statistically significant. Similar findings were observed in grade I patients too (P < 0.05). In all cases examined here, the AD group had a significantly shorter time for drain removal compared to the PD group (3.04 [1–12] vs 2.74 [1–15], P = 0.049); this difference was also evident among grade I patients (2.80 [1–6] vs 2.47 [1–9], P = 0.019). Furthermore, within the same grade, only in grade IV did the AD group exhibit a shorter duration of postoperative antibiotic use compared to the PD group (4.75 [4–5] vs 8.33 [5–15], P = 0.009). Additionally, the LOH in the AD group was longer than that in the PD group (8.00 [4–13] vs 4.75 [4–5], P = 0.025). Among all cases, the ND group exhibited significantly lower incidences of overall complications and WI compared to the other two groups (P < 0.05). Additionally, the incidence of IAA in the ND group was significantly lower than that in the PD group (0% vs 5.3%, P = 0.008 < 0.0167). Furthermore, although there were no statistically significant differences in the incidence of overall complications, IAA, ileus, and WI between the PD and AD groups during grade ≥ II analysis (P > 0.05), a higher readmission rate within 30 days was observed in the PD group compared to the AD group; however, these differences were not statistically significant (P > 0.05). Moreover, multivariate analysis revealed that a higher grade of appendicitis was associated with an increased risk of overall complications and IAA as well as a longer duration of postoperative antibiotic use and LOH.
Conclusion
The appendicitis grade is a crucial indicator for predicting postoperative IAA and LOH. In patients with grade I appendicitis, peritoneal drainage, even if active drainage, is not recommended; For patients with grade ≥ II appendicitis, active drainage may be more effective than passive drainage in reducing the duration of postoperative antibiotic use and LOH.