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Safety of appendectomy in pediatric patients with synchronous oncologic diagnosis: An analysis using the National Surgical Quality Improvement Project, Pediatric
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  • Andrew Claffey,
  • Dave Lal,
  • Timothy Lautz,
  • Denise Rokitka,
  • David Rothstein
Andrew Claffey
University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Dave Lal
Medical College of Wisconsin
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Timothy Lautz
Ann and Robert H Lurie Children's Hospital of Chicago
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Denise Rokitka
University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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David Rothstein
University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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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.