Sex disparities in emergency presentation and outcomes of pediatric complicated appendicitis

Purpose: We aimed to assess sex-related differences in the presentation to an emergency department, perioperative management, and outcomes of complicated appendicitis.Methods: A retrospective cohort study was conducted on patients under 18 years who presented to the emergency department and subsequently underwent laparoscopic appendectomy for complicated appendicitis from 2012 through 2022 at a single tertiary medical center in Israel. We analyzed data from the patients’ medical records, in terms of age, sex, duration of symptoms, clinical presentation, laboratory or imaging findings, intraoperative findings, and postoperative outcomes.Results: Among 300 patients (123 females [41.0%]), no significant sex differences were observed in the age, duration of symptoms, clinical presentation, and laboratory, imaging, or intraoperative findings. We noted that the female patients showed a more frequent antibiotic escalation from ceftriaxone-metronidazole to piperacillin-tazobactam (males, 14.7% vs. females, 25.2%; P = 0.020) and a longer median hospital length of stay (6.0 days [interquartile range, 5.0-8.0] vs. 7.5 days [5.0-10.0]; P = 0.048). No difference was observed in the rates of resistant bacteria detected from the intraoperatively obtained intra-abdominal fluids (males, 14.1% vs. females, 18.7%; P = 0.103). In a sub-analysis on patients undergoing the antibiotic escalations, the females showed a longer median duration of symptoms before hospitalization (males, 2.0 days [interquartile range, 1.0-3.0] vs. females, 3.0 days [2.0-4.5]; P = 0.031), and a higher frequency of intra-abdominal fluids on postoperative ultrasonography (23.1% vs. 32.3%; P = 0.049).Conclusion: Female pediatric patients with complicated appendicitis may experience worse postoperative outcomes. This finding prompts primary care providers and caregivers to raise awareness about the early signs of appendicitis in females, which could reduce delays in seeking emergency care.