Trends in Simple and Complex Appendicitis in Children and the Potential Correlation to Common Viral Pathogens-A Retrospective Cohort Study between 2010 and 2019 in The Netherlands

Abstract

The aim of this study was to evaluate the annual, seasonal and monthly trends in children with simple and complex appendicitis and their correlation to common viral pathogens in the Netherlands. A consecutive multicenter retrospective cohort study was performed between 2010 and 2019 including children (<18 years) surgically treated for appendicitis. The primary outcome was the distribution of children with simple and complex appendicitis per year, season and month. Relevant seasonal variation was defined as ≥5%. The secondary outcome was a positive correlation of the number of patients with simple and complex appendicitis to common viral pathogens (data anonymously provided by the Dutch Working Group on Clinical Virology from the Dutch Society for Clinical Microbiology (NVMM)). In total, 896 patients were included: N = 524 (58%) patients with simple and N = 372 (42%) with complex appendicitis. Of the children aged 0-5 years, 81% had complex appendicitis, versus 38% in 6-18 years (p < 0.001). An overall decline was demonstrated for both simple and complex appendicitis between 2010 and 2019. No seasonal variation was found for simple appendicitis. For complex appendicitis, the highest number of patients was found in spring, and lowest in summer (N = 372, spring 28.2 ± 5.1% versus summer 21.0 ± 5.8%, p = 0.011), but the variance was regarded as not relevant (<5% from baseline). A positive correlation was found between complex appendicitis with Adenovirus 40.41 (R = 0.356, 95%CI 0.045-0.604, p = 0.026) and simple appendicitis with Adenovirus NON 40.41 (R = 0.332, 95%CI 0.019-0.586, p = 0.039), but these correlations did not remain significant after a Bonferroni correction (p < 0.003). In conclusion, we found no relevant seasonal variation for simple or complex appendicitis, nor positive correlation with common viral pathogens.

Keywords: appendicitis; children; complex; simple; viral pathogens.

Figure 1

Inclusion Flowchart.

Figure 2

Age of included patients for simple and complex appendicitis. Cumulative number of patients with appendicitis over a time-span of 10 years: simple appendicitis N = 524, complex appendicitis N = 372.

Figure 3

Age of included patients for perforated appendicitis. Cumulative number of patient over a time-span of 10 years: perforated appendicitis N = 267.

Figure 4

Annual incidence of appendicitis. Dots represent number of patients per year. A significant decrease was noted over the years for simple and complex appendicitis (linear regression analysis, simple slope = −3.188, 95%CI −4.663–−1.713, R² = 0.756, p = 0.001; complex slope = −2.509, 95%CI −4.759–−0.259, R² = 0.453, p = 0.033), but not for perforated appendicitis.

Figure 5

Viral correlation analysis.