Quality of care received by children with suspected appendicitis in the UK National Health Service.

Abstract

Appendicitis is one of the most common emergency surgical pathologies in childhood. This study used data from the Children's Acute Surgical Abdomen Programme study to describe compliance with published standards of care and the relationship between care delivery and 30-day postoperative morbidity for children aged 1-16 y undergoing appendicectomy. Data were collected from 80 hospitals and this included the type of care delivered, the setting in which care was provided and patient level factors. Bivariable and multivariable analysis was undertaken to identify associations between care delivery and outcome. Data collected from 2799 children highlighted variation in care provision related to the use of pre-operative imaging, multimodal analgesia and the proportion of children undergoing surgery within 24 h of presentation; compliance with these standards was 42.6%, 70.8% and 72.8%, respectively. Children managed in specialist paediatric centres were younger, with a higher burden of chronic disease and higher rates of complicated appendicitis. They were also less likely to have a negative appendicectomy but more likely to experience postoperative complications. Despite a high compliance with published recommendations for several aspects of care, deficiencies were identified. A focused effort is needed to improve diagnostic accuracy, optimise analgesia management and reduce the duration of time for which children are waiting for surgery. Similarly, further work is required to better understand the increased rates of postoperative morbidity seen in specialist paediatric centres. Addressing these factors may lead to discernible improvements in experience and outcomes for children with suspected appendicitis.