O2149: Developmentally Delayed Children with Appendicitis Have a More Complicated Disease Course

Background: Appendicitis is one of the most common surgical diagnoses in children. Developmentally delayed children may have communication impairments that can complicate their medical care. We hypothesized that children with developmental delay are more likely to present with more severe appendicitis and have worse clinical outcomes.

Methods: The American College of Surgeons National Surgical Quality Improvement Program Pediatric procedure targeted appendectomy Participant User File was obtained from 2015 to 2020. Primary outcome was perforated appendicitis. Secondary outcomes included length of stay, PICC placement, parenteral nutrition requirement, Clostridium difficile colitis, post-operative ED visits and readmissions. These outcomes were compared between patients with and without developmental delay.

Results: 94,013 patients who underwent appendectomy for appendicitis were included. 1,688 (1.80%) of those patients were developmentally delayed. Both intraoperative complicated appendicitis rate (33.77% vs. 27.79%, p< 0.0001) and normal appendix rate (4.03% vs. 2.38%, p< 0.0001) were significantly higher in developmentally delayed patients. These patients had higher rates of receiving parenteral nutrition during admission (4.74% vs. 1.86%, p< 0.0001) and longer length of stay (2 days vs. 1 day, p< 0.0001). On multivariable regression, developmentally delayed status was significantly associated with longer length of stay (1.048, 95% CI 1.039-1.057, p< 0.0001) when controlling for complicated appendicitis, PICC placement and parenteral nutrition requirement. These children were also more likely to have Clostridium difficile colitis (1.06% vs. 0.34%, p< 0.0001) and to be discharged to an acute/skilled care or rehab facility (0.53% vs. 0.16%, p=0.004). Lastly, these patients had more frequent post-operative ED visits (11.32% vs. 7.76%, p< 0.0001) leading to higher readmission rates within 30 days (15.86% vs. 8.21%, p< 0.0001), but these readmissions were less likely to be related to surgical complications (76.19% vs. 86.57%, p=0.002).

Conclusion: Patients with developmental delay have higher rates of complicated appendicitis resulting in more complex post-operative care. These patients represent a distinct patient population that require more thoughtful management strategies during treatment of appendicitis. Closer attention should be paid during diagnosis, peri-operative, and post-operative management of developmentally delayed children with signs and symptoms of appendicitis.