Key result
General surgeons match pediatric surgeons in appendectomy outcomes but carry ~47% higher negative appendectomy risk.
Why the study?
Both general surgeons and pediatric surgeons perform high volumes of pediatric appendectomies, but data comparing outcomes based on surgeon training are limited.
Does appendectomy performed by general surgeons compared to pediatric surgeons affect postoperative outcomes and resource utilization in pediatric patients?
Meta-Analysis
Does appendectomy performed by general surgeons compared to pediatric surgeons affect postoperative outcomes and resource utilization in pediatric patients?
Pediatric appendectomies performed by general surgeons have similar outcomes and resource utilization to those performed by pediatric surgeons, except for a higher risk of negative appendectomies.
General surgeons performing pediatric appendectomies warrant caution to avoid excess negative explorations; extends meta-analytic evidence on surgeon specialization outcomes.
Background: Both general surgeons (GS) and pediatric surgeons (PS) perform a high volume of appendectomies in pediatric patients, but there is a paucity of data on these outcomes based on surgeon training. We performed a systematic review and meta-analysis to compare postoperative outcomes and perioperative resource utilization for pediatric appendectomies. Methods: We searched PubMed to identify articles examining the association between surgeon specialization and outcomes for pediatric patients undergoing appendectomies. Study selection, data extraction, risk of bias assessment, and quality assessment were performed by one reviewer, with another reviewer to resolve discrepancies. Results: We identified 4799 articles, with 98.4% (4724/2799) concordance after initial review. Following resolution of discrepancies, 16 studies met inclusion criteria. Of the studies that reported each outcome, GS and PS demonstrated similar rates of readmission within 30 days (pooled RR 1.61 95% CI 0.66, 2.55) wound infections (pooled RR 1.07, 95% CI .55, 1.60), use of laparoscopic surgery (pooled RR 1.87, 95% CI .21, 3.53), postoperative complications (pooled RR 1.40, 95% CI .83, 1.97), use of preoperative imaging (pooled RR .98,95% CI .90, 1.05), and intra-abdominal abscesses (pooled RR .80, 95% CI .03, 1.58). Patients treated by GS did have a significantly higher risk of negative appendectomies (pooled RR 1.47, 95% CI 1.10, 1.84) when compared to PS. Discussion: This is the first meta-analysis to compare outcomes for pediatric appendectomies performed by GS compared to PS. Patient outcomes and resource utilization were similar among PS and GS, except for negative appendectomies were significantly more likely with GS.
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Eakes et al. (2023) conducted a meta-analysis in Pediatric appendectomies. General surgeons vs. Pediatric surgeons was evaluated on Negative appendectomies (RR 1.47, 95% CI 1.10-1.84). Pediatric appendectomies performed by general surgeons had similar outcomes to pediatric surgeons, except for a significantly higher risk of negative appendectomies (pooled RR 1.47; 95% CI 1.10-1.84).
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