• Andrew B Nordin, Karen Diefenbach, Stephen P Sales, Jeff Christensen, Gail E Besner, and Brian D Kenney.
• Nationwide Children's Hospital, Department of Pediatric Surgery, 700 Children's Drive, Columbus, OH, 43205; State University of New York University at Buffalo, Department of General Surgery, 100 High St, Buffalo, NY 14203. Electronic address: abnordin@buffalo.edu.
• J. Pediatr. Surg. 2019 Apr 1; 54 (4): 718-722.

BackgroundAppendicitis presents on a spectrum ranging from inflammation to gangrene to perforation. Studies suggest that gangrenous appendicitis has lower postoperative infection rates relative to perforated cases. We hypothesized that gangrenous appendicitis could be successfully treated as simple appendicitis, reducing length of stay (LOS) and antibiotic usage without increasing postoperative infections.MethodsIn February 2016, we strictly defined complex appendicitis as a hole in the appendix, extraluminal fecalith, diffuse pus or a well-formed abscess. We switched gangrenous appendicitis to a simple pathway and reviewed all patients undergoing laparoscopic appendectomy for 12 months before (Group 1) and 12 months after (Group 2) the protocol change. Data collected included demographics, appendicitis classification, LOS, presence of a postoperative infection, and 30-day readmissions.ResultsPatients in Group 1 and Group 2 were similar, but more cases of simple appendicitis occurred in Group 2. Average LOS for gangrenous appendicitis patients decreased from 2.5 to 1.4 days (p < 0.001) and antibiotic doses decreased from 5.2 to 1.3 (p < 0.001). Only one gangrenous appendicitis patient required readmission, and one patient in each group developed a superficial infection; there were no postoperative abscesses.ConclusionsGangrenous appendicitis can be safely treated as simple appendicitis without increasing postoperative infections or readmissions.Type Of StudyPrognosis study.Level Of EvidenceLevel II.Copyright © 2018 Elsevier Inc. All rights reserved.

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