57 - DIFFERENCES IN POST-OPERATIVE OUTCOMES AND PERIOPERATIVE RESOURCE UTILIZATION BETWEEN GENERAL SURGEONS AND PEDIATRIC SURGEONS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objectives: Both general surgeons (GS) and pediatric surgeons (PS) perform a high volume of appendectomies in pediatric patients. However, there is very little data on differential outcomes based on surgeon training. We hypothesize that GS and PS have similar outcomes for pediatric appendicitis. However, data examining this topic are primarily single institution studies; thus, we performed a systematic review and meta-analysis to compare post-operative outcomes and peri-operative 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 two reviewers, with a third review to resolve discrepancies. Studies were excluded if no comparison between surgical specialization was performed.

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 0.55, 1.60), use of laparoscopic surgery (pooled RR 1.87, 95% CI 0.21, 3.53), post-operative complications (pooled RR 1.40, 95% CI 0.83, 1.97), use of pre-operative imaging (pooled RR 0.98,95% CI 0.90, 1.05), and intra-abdominal abscesses (pooled RR 0.80, 95% CI 0.03, 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.

Conclusion: This is the first meta-analysis to compare outcomes for pediatric appendectomies performed by GS compared to PS. The outcomes are similar between the two groups of surgeons, except for negative appendectomies, which are more likely to occur when performed by GS. This study is limited by existing literature comparing outcomes of series reported within single centers and may not be generalizable. However, this does highlight the importance of aggregating data for children and adolescents undergoing common general surgical procedures outside of children’s hospitals to ensure high-quality care delivery.