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Comparative Study
. 2021 Dec 1;274(6):e599-e604.
doi: 10.1097/SLA.0000000000003804.

Abdominal Drainage at Appendectomy for Complicated Appendicitis in Children: A Propensity-matched Comparative Study

Jun Fujishiro  1   2 , Michimasa Fujiogi  1   2 , Norimichi Hirahara  2   3 , Keita Terui  2 , Tatsuya Okamoto  2 , Eiichiro Watanabe  1   2 , Tetsuya Ishimaru  1 , Hiroaki Miyata  3
Affiliations
Comparative Study

Abdominal Drainage at Appendectomy for Complicated Appendicitis in Children: A Propensity-matched Comparative Study

Jun Fujishiro et al. Ann Surg. .

Abstract

Objective: The aim of the study was to investigate the effect of abdominal drainage at appendectomy for complicated appendicitis in children.

Summary of background data: Although an abdominal drain placement at appendectomy is an option for reducing or preventing postoperative infectious complication, there is controversy regarding its effect for complicated appendicitis.

Method: The study used the data on appendectomies for complicated appendicitis in children (≤15 years old) that were operated in 2015 and registered in the National Clinical Database, a nationwide surgical database in Japan. One-to-two propensity score matching was performed to compare postoperative outcomes between patients with and without drainage at appendectomy.

Result: The study included 1762 pediatric appendectomies for complicated appendicitis, 458 of which underwent abdominal drainage at appendectomy. In the propensity-matched analysis, the drainage group showed a significant increase in wound dehiscence [drain (-) vs drain (+); 0.3% vs 2.4%, P = 0.001], and postoperative hospital stay (median: 7 days vs 9 days, P < 0.001). There were no significant differences in the incidence of any complications, organ space surgical site infection, re-admission, and reoperation.Subgroup analyses in perforated appendicitis and perforated appendicitis with abscess, and open and laparoscopic appendectomy all demonstrated that drain placement was not associated with a reduction in any complication or organ space surgical site infection. However, it was significantly associated with longer hospital stays.

Conclusion: This study suggested that an abdominal drain placement at appendectomy for complicated appendicitis among children has no advantage and can be harmful for preventing postoperative complications.

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Conflict of interest statement

The authors report no conflicts of interest.

References

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    1. Haller JA Jr, Shaker IJ, Donahoo JS, et al. Peritoneal drainage versus non-drainage for generalized peritonitis from ruptured appendicitis in children: a prospective study. Ann Surg 1973; 177:595–600.
    1. Li Z, Zhao L, Cheng Y, et al. Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. Cochrane Database Syst Rev 2018; 5:CD010168.
    1. The National Clnical Database. Available at: http://www.ncd.or.jp/2019 . Accessed February 21, 2019

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