The contribution of practice variation to length of stay for children with perforated appendicitis

Teresa S. Gross, Courtney McCracken, Kurt F. Heiss, Mark L. Wulkan, Mehul V. Raval*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background Postoperative length of stay (pLOS) is an easily tracked outcome that reflects health care efficiency and resource utilization. The purpose of this study was to determine the contribution of practice variation on pLOS for children with perforated appendicitis. Methods Children ages 2–18 years with appendectomy for complicated appendicitis were selected from the National Surgical Quality Improvement Program-Pediatric. Extended pLOS (EpLOS) was defined as ≥ 7 days (75th percentile). The contribution of comorbidities, operative traits, and postoperative complications to EpLOS was evaluated using regression models and matched subgroup analyses. Results Of 2585 children with complicated appendicitis in our study, 835 had EpLOS. Regression analysis found that EpLOS was associated with extended operative time (odds ratio (OR) 1.99; 95% confidence interval (CI) 1.63–2.44), dehiscence (OR 13.19; 95% CI 1.52–114.23), wound infection (OR 7.39; 95% CI 2.63–20.80), organ space infection (OR 92.51; 95% CI 34.03–251.50), and pneumonia (OR 4.55; 95% CI 1.06–19.44). Over three-fourths of the variation in pLOS could not be explained by preoperative, intraoperative, or postoperative factors. Conclusions There is significant variation in pLOS for children undergoing appendectomy that is not accounted for by comorbidities, operative traits, or complications indicating an opportunity to improve outcomes through modifying practice patterns.

Original languageEnglish (US)
Pages (from-to)1292-1297
Number of pages6
JournalJournal of pediatric surgery
Issue number8
StatePublished - Aug 1 2016


  • Determinants of length of stay appendectomy
  • Enhanced recovery after surgery
  • Length of stay
  • Perforated appendicitis
  • Postoperative
  • Postoperative protocol
  • Practice variation

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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