Profile of paediatric patients with appendicitis at an academic hospital after admission criteria change
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Abstract
Background. Appendicitis is the most common surgical emergency in children. During the COVID-19 pandemic, Chris Hani Baragwanath Academic Hospital (CHBAH) raised the cut-off age for paediatric surgery admission from 10 to 14 years owing to constraints placed on pre- existing systems. This change resulted in a new profile of appendicitis cases within the department.
Objectives. To describe the profile of paediatric patients with appendicitis at CHBAH following the implementation of an age limit change in admission criteria.
Methods. This retrospective descriptive study reviewed all patients aged ≤14 years who were managed for appendicitis in the Department of Paediatric Surgery at CHBAH between July 2020 and June 2023.
Results. A total of 308 patients was included in the study. The mean age at presentation was 9.4 years, with a male-to-female ratio of 1.6:1. Almost half (45.1%) of the patients were >10 years of age. Of the total patients, over two-thirds (69.5%) presented with complicated appendicitis, and almost all (95.1%) underwent surgical management. Compared with patients with uncomplicated appendicitis, those with complicated appendicitis had significantly more postoperative complications (p<0.001), a higher re-admission rate (p=0.004), required more re-look procedures (p<0.001), had longer hospital stays (p<0.001), and had a higher mortality rate (p<0.001).
Conclusions. This study reveals a concerning prevalence of complicated appendicitis in paediatric patients, highlighting the necessity for prompt diagnosis and intervention. An increased patient load strained paediatric surgery hospital resources, while the COVID-19 pandemic likely worsened treatment delays. Ongoing research is essential for optimising management strategies and improving surgical outcomes.
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