Preoperative inflammatory markers in pediatric appendicitis: associations with disease severity, postoperative recovery, pain, and surgical outcomes.
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OBJECTIVE: This study aims to evaluate the associations between preoperative inflammatory markers and both disease severity, postoperative outcomes (recovery, pain, complications) and postoperative outcomes (recovery, pain, complications) among pediatric patients with pathologically confirmed acute appendicitis. METHODS: This retrospective cohort study analyzed 150 pediatric patients with pathologically confirmed acute appendicitis and included 150 healthy controls solely to establish baseline inflammatory marker levels. Preoperative inflammatory markers including white blood cell count (WBC), neutrophils (NEU), procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6), along with Alvarado scores were recorded. Postoperative outcomes included time to ambulation, bowel sound recovery, first defecation, hospital stay duration, 12-hour Visual Analog Scale (VAS) pain scores, and complication rates. All further analyses regarding severity and outcomes were conducted within the appendicitis cohort. RESULTS: The preoperative levels of WBC, PCT, CRP, TNF-α, and IL-6 in patients with appendicitis were significantly higher than those in the healthy control group (p < 0.001). Among children with appendicitis, preoperative inflammatory indicators showed strong correlations with Alvarado scores (P < 0.001), and moderate to strong correlations with postoperative bowel sound recovery time (r = 0.5677-0.7698) and hospital stay duration (r = 0.4481-0.5727). Moderate correlations were also observed with postoperative ambulation time (r = 0.3286-0.5676), and weak correlations with time to oral intake (r = 0.3172-0.4727) and postoperative defecation time (r = 0.2354-0.4905). VAS pain scores (r = 0.4558-0.6196) and complication rates (r = 0.4408-0.5684) were also positively correlated with inflammatory markers (all P < 0.001). CONCLUSION: Elevated preoperative inflammatory markers are associated with increased disease severity and can predict prolonged recovery, higher postoperative pain, and a greater risk of complication among confirmed pediatric appendicitis cases. These findings support their clinical use in risk stratification and personalized perioperative management.