WOFAPS 2025 8th World Congress of Pediatric Surgery

Jurate Pakrosnyte, Nora Visockyte, Dalius Malcius, Ausra Lukosiute- Urboniene

Lithuanian University of Health Sciences, Kaunas clinics

Purpose: This study aimed to evaluate risk factors and microbiological predictors of early postoperative outcomes in children with perforated appendicitis.

Materials & Methods: A retrospective single-center analysis of 528 children (<18 years) undergoing appendectomy for perforated appendicitis was conducted between 2010 and 2021. Demographic, clinical, microbiological, and intraoperative data were reviewed. Surgical site infections (SSI), length of stay (LOS), and postoperative interventions were assessed as outcomes. Data were analyzed using statistical tests, with p-values <0.05 considered significant.

Results: Microbiological cultures were obtained in 390 patients (73.2%), yielding positive results in (349) 87.2%. Escherichia coli 282 (80%), Bacteroides fragilis 116 (33.2%), Pseudomonas aeruginosa 56 (16%), and β - hemolitical streptococcus 33 (15%) were the most frequent pathogens. Surgical site infections were observed in 11.36% (60/ 528) patients, including 31 cases of wound infection and 29 cases of abdominal abscess. Risk factors for SSI included elevated C-reactive protein (CRP >100 mg/L; p=0.02), presence of intraoperative abscesses (p=0.01), growth of Enterococcus spp. (p=0.01) and Pseudomonas aeruginosa (p=0.002), despite the fact that all patients with pseudomona got empiric antipseudomonal therapy. Logistic regression identified Pseudomonas infection (RR 3.3, 95% CI (1.6-6.9)) and abscess on the first surgery (RR 5.1, 95% CI (2.6-9.8)) as significant predictors for early postoperative complications, p<0.05.

Conclusions: Presence of intraoperative abscesses and specific pathogen as Pseudomonas are critical risk factors for early postoperative complications. Microbiological profiling and culture-guided antibiotic adjustments are essential for managing pediatric perforated appendicitis.