• Stefano Giuliani, Elizabeth V Cecil, Nadja Apelt, Michael Sharland, and Sonia Saxena.
• *Department of Paediatric and Neonatal Surgery, St George's Healthcare NHS Trust and University of London, London, UK †Department of Primary Care and Public Health, Imperial College London, London, UK ‡Kinderchirurgische Klinik und Poliklinik, Dr. von Haunersches Kinderspital, Munich, Germany §Department of Paediatric Infectious Disease, St George's Healthcare NHS Trust and University of London, London, UK.
• Ann. Surg. 2016 Jan 1; 263 (1): 184-90.

ObjectiveTo compare trends in pediatric emergency appendectomy and adverse surgical outcomes between district general hospitals (DGHs) and specialist pediatric centers (SPCs).BackgroundIn the past decades in England, a significant reduction in the number of children operated by adult general surgeons has raised concerns about their surgical outcomes compared with specialist pediatric surgeons.MethodsUsing Hospital Episode Statistics, we analyzed patient-level data between April 2001 and March 2012. Main inclusion criteria were children younger than 16 years admitted to NHS-England hospitals for an emergency appendectomy. Main outcomes were annual age-sex adjusted appendectomy rates and postoperative risk of readmission, complication, and reintervention.ResultsA total of 83,679 emergency pediatric appendectomies were performed in 21 SPCs and 183 DGHs in England. SPCs performed only 18% of these operations (15,002). Annual age-sex standardized appendectomy rates fell from 87 to 68 per 100,000 population at an estimated 2% (rate ratio, 0.98) fall per annum. This was accompanied by a national annual increased risk of negative appendectomy, complication, reintervention, and readmission (adjusted odds ratio: 1.02, 1.03, 1.04, and 1.06, respectively). Children who had appendectomies in DGHs had 28% more negative appendectomies, 11% more complications, and 11% more readmissions than those in SPCs. Postoperative length of stay was double in SPCs compared with DGHs (median, 4 vs 2 days).ConclusionsMajor reductions in the number of pediatric emergency appendectomies in England over the past decade were associated with an overall increase in adverse surgical outcomes. Children operated in DGHs have more reinterventions, complications, and negative appendectomy rates than those operated in SPCs.

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