Postoperative timing of computed tomography scans for abscess in pediatric appendicitis.

Background: One-quarter to one half of pediatric appendicitis patients present with ruptured appendicitis and about 3%-25% go on to form postoperative intra-abdominal abscesses. The optimal timing of postoperative imaging for suspected abscess formation has been a subject of debate.

Methods: All patients who underwent appendectomy for complex appendicitis and were not discharged before postoperative day (POD) #5 from April 2012-October 2014 were identified. Patients were stratified into groups for comparison as follows: group 1 had postoperative computed tomography (CT) scans before POD#7 (n = 26) and group 2 did not (n = 169). Group 2 was further divided into those who were afebrile (group 2a, n = 106) or febrile (group 2b, n = 63) at POD#5.

Results: A total of 195 patients met criteria. Early use of CT scans resulted in more drainage procedures (group 1, 73.1% versus group 2b, 28.6%, P < 0.001) and a higher recurrent CT scan rate (38.5% versus 9.5%). The groups had equivalent lengths of stay (11.9 versus 9.8 d, P = 0.10) and readmission rates due to abscesses (19.2% group 1 versus 6.3%, group 2b, P = 0.12) with no septic events. In total, 130 of the 169 patients (76.9%) in group 2 had resolution of symptoms before discharge without intervention with readmission for abscess in only 5.9%.

Conclusions: Waiting until POD#7 before scanning led to fewer drainage procedures and recurrent CT scans without increasing length of stay or readmission rates. Most complex appendicitis patients still admitted at POD#5 had resolution of symptoms without need for intervention.