494 - Late Complications of Pediatric Appendicitis

Immediate complications occur in 25% of children with appendicitis but rates and predictors of late complications are unclear.

Objective:

We sought to determine rates and predictors of late complications of pediatric appendicitis.

Design/Methods:

We included children under age 18 years with a first diagnosis of appendicitis in the Transformed Medicaid Statistical Information System Analytic File (a national Medicaid claims database) between 1/1/2018-12/31/2019. The main outcome was time to a late complication, defined as the first hospitalization or invasive abdominal procedure after the index encounter (excluding interval appendectomy care). Patients censored at the end of the study or at expiration of Medicaid eligibility. We evaluated univariable associations between late complications within 30 or 90 days and age, sex, race, child opportunity index (COI) of the patient’s ZIP code, prior complex chronic condition (CCC), and presence of appendiceal perforation at diagnosis. We used a Cox model to evaluate multivariable associations between significant covariates and time to late complications. We also assessed subsequent care within 90 days. A subanalysis of patients with cost data available evaluated 90-day costs as measured by actual payments for care.

Results:

We analyzed 96,848 children with a median follow-up time of 318 days (IQR 144, 513). Late complications occurred within 30 days among 4,728 (4.9%) within 90 days among 5,700 (5.9%), and before the end of follow-up among 7,196 (7.4%). Thirty- and 90-day complications were highest in the youngest children, non-Hispanic White and Black patients, those with CCCs, and after perforated appendicitis (p< 0.001 for each, Table). There was no association with sex or COI. Time to complications was shorter with decreasing age, CCCs, perforated appendicitis, and in American Indian/Alaska Native and Hispanic patients (Table). The median number of clinic visits within 90 days among those with and without late complications were 2 (IQR 1-3) and 1 (1-2), p< 0.001. The median number of ED/inpatient encounters within 90 days was 2 (IQR 2-3) among those with late complications and 1 (1-2) among those without, p< 0.001. Median 90-day costs were $16,286 (IQR 7,068-52,346) among those with late complications and $7,070 (IQR 3,541-16,973) among those without.

Conclusion(s):

Late complications occurred among a minority of patients and were more common in children with perforated appendicitis or CCCs. Late complications were associated with increased need for care and higher costs.