Risk factors for surgical difficulty in interval appendectomy for perforated appendicitis with abscess in children

To predict surgical difficulty during interval appendectomy for perforated appendicitis with abscess. The records of children diagnosed with appendiceal abscess who underwent interval appendectomy from 2012 to 2024 were reviewed. The clinical data associated with difficult surgeries (operative time > 2 h or addition of trocars) and uncomplicated surgeries were compared. Among the 61 children who underwent interval appendectomy, 42 had uncomplicated surgery, whereas 19 children had difficult surgery. Children who underwent difficult surgery were older (11.5 ± 3 vs. 8.8 ± 3 years, p = 0.001), taller (p = 0.009), and weighed more (p = 0.011) compared to those who had uncomplicated surgery. In addition, difficult surgery was associated with larger abscesses (p = 0.003) and longer initial hospital stay (p = 0.046). Multivariate analysis identified older age (OR = 1.36; 95% CI = 1.08-1.8; p = 0.017), longer abscess diameter (OR = 1.36; 95% CI = 0.96-2.02; p = 0.097), and longer initial hospital stay (OR = 1.03; 95% CI = 1-1.07; p = 0.097) as possible risk factors for difficult surgery. According to ROC analysis, the cut-off values of age, abscess diameter, and length of hospital stay for predicting complicated appendectomy were 10.4 years, 5.8 cm, and 16.5 days, respectively. Older age, larger abscesses, and longer hospital stay for non-operative treatment may contribute to increased surgical difficulty during interval appendectomy.