Intra-abdominal Abscess After Appendectomy-Are Drains Necessary in All Patients?

Abstract

BACKGROUND:

Research has shown that patients who develop a postoperative intra-abdominal abscess (PIAA) after appendectomy have a greater number of health care visits with drain placement. Our institution developed an algorithm to limit drain placement for only abscesses with a size >20 cm2. We sought to determine the adherence to and effectiveness of this algorithm.

METHODS:

This prospective observational study included patients aged 2-18 y old who developed a PIAA from September 2017 to June 2019. Outcomes were compared between patients with a small or large abscess. Analysis was performed in STATA; P < 0.05 was significant.

RESULTS:

Thirty patients were included. The median age was 10.6 y (7, 11.7); 60% were men, and 60% were Caucasian. The median duration of symptoms before diagnosis of appendicitis was 3 d (2, 6). Thirteen patients (43%) were diagnosed with a PIAA while still inpatient, and 17 (57%) were readmitted at a later date. After algorithm implementation, 95% (n = 19) of patients with a large abscess had aspiration ± drain placement, whereas 30% (n = 3) with a small abscess underwent drainage. Length of stay after abscess diagnosis, total duration of antibiotics, and number of health care visits were the same between groups. One patient with a small abscess required reoperation for an obstruction, whereas one patient with a large abscess that was drained was readmitted for a recurrent abscess.

CONCLUSIONS:

Small PIAA can be successfully managed without intervention. Our proposed algorithm can assist in determining which patients can be treated with antibiotics alone.

• Authors: Wendy Jo Svetanoff, Neal Talukdar, Charlene Dekonenko, Robert M Dorman, Obiyo Osuchukwu, Jason D Fraser, Tolulope A Oyetunji, Shawn D St Peter
• Journal: The Journal of surgical research (J Surg Res) Vol. 254 Pg. 384-389 (10 2020) ISSN: 1095-8673 [Electronic] United States
• PMID: 32535257 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2020. Published by Elsevier Inc.

Topics

• Abdominal Abscess (etiology, surgery)
• Adolescent
• Algorithms
• Appendectomy (adverse effects)
• Child
• Child, Preschool
• Drainage
• Female
• Guideline Adherence (statistics & numerical data)
• Humans
• Length of Stay
• Male
• Prospective Studies
• Unnecessary Procedures (statistics & numerical data)