Safety of appendectomy in pediatric patients with synchronous oncologic
diagnosis: An analysis using the National Surgical Quality Improvement
Project, Pediatric
Abstract
Background Optimal treatment of children who develop appendicitis while
undergoing treatment for an oncologic diagnosis has not been defined, in
part due to theoretical concerns for an increased risk of post-operative
wound complications. We hypothesized that synchronous oncologic
diagnosis conferred no increased odds of developing a wound complication
in pediatric patients undergoing appendectomy. Methods Retrospective
cohort study using the National Surgical Quality Improvement Program,
Pediatric (2012-2017) of patients <18 years of age undergoing
appendectomy. The main exposure variable was active treatment for an
oncologic diagnosis. The primary outcomes of interest were 30-day wound
complications (superficial or deep infections or dehiscence, and
abscess). For univariate analysis comparison of baseline differences
between patients with/without a cancer diagnosis we employed Pearson’s
χ2 and two sample t-tests. Multivariate logistic regression was used to
evaluate which covariates were independently associated with our
outcome. Results We identified 28219 patients who had undergone
appendectomy; 95 (0.3%) were undergoing oncologic treatment at time of
surgery. Patients in the cancer group were more likely to be receiving
steroids, have lower white blood cell counts and have higher American
Society of Anesthesiology classes compared to the non-cancer patients.
Age, gender, rates of perforation and laparoscopy were similar between
the two groups. Patients with an active cancer diagnosis suffered wound
complications (measured individually and as an aggregate) at no higher
odds than those without a cancer diagnosis. Conclusion Pediatric
patients undergoing treatment for cancer do not have increased odds of
suffering post-operative wound complications following appendectomy
compared to the general population.