Appendectomy is associated with increased risk of non-typhoidal Salmonella infection in children

1. Appendectomy was associated with a higher risk of non-typhoidal Salmonella infection in children.

Evidence Rating Level: 2 (Good)

Study Rundown: Appendectomy is one of the most common emergency surgeries. As the appendix contains lymphoid cells involved in immune function, its removal may increase the risk of infections. Non-typhoidal Salmonella (NTS) is a group of bacteria that commonly cause foodborne illness and can lead to severe invasive bacteremia and disseminated disease, particularly in vulnerable populations such as children. However, the association between appendectomy and NTS infection is unclear. This study thus investigated the association between appendectomy and the risk of developing NTS infections in children.

This study included Taiwanese children who underwent appendectomy and matched them with children without appendectomy. The exposure was appendectomy during childhood, and the primary outcome was incidence of NTS infection. Of the 93,270 children included in the analysis, 18,654 were in the appendectomy group, and 7,4 616 were in the matched control group. Children who underwent appendectomy had a 58% higher risk of NTS infection compared with children in the control group. Stratified analyses showed that compared with children who did not undergo appendectomy, those in the appendectomy group had a higher risk of NTS infection among children under 5 years of age, males, and those living in rural areas.

Overall, this study found that appendectomy among children was associated with an increased risk of NTS infection.

Click to read the study in JAMA Network Open

Relevant reading: Children with appendectomy have increased risk of future sepsis: Real-world data in Taiwan

In-Depth [retrospective cohort study]:

This study analyzed data from Taiwan’s National Health Insurance Research Database between January 1, 2000, and December 31, 2019. Children (<18 years) who underwent appendectomy were matched to children without appendectomy in a 1:4 ratio based on age, sex and index date. The exposure was appendectomy during childhood, and the primary outcome was incidence of NTS infection, defined as three outpatient or one inpatient diagnosis after the index date. Of the 93,270 children included in the analysis, 18,654 were in the appendectomy group (mean [SD] age, 10.04 (4.17) years; 11,883 [63.7%] male) and 7,4 616 were in the matched control group (mean [SD] age, 9.73 [4.30] years; 47,532 [63.7%] male). Children who underwent appendectomy had a 58% higher risk of NTS infection compared with children in the control group (adjusted hazard ratio (aHR), 1.58; 95% CI, 1.17-2.13). Children under 5 years of age in the appendectomy group had double the risk of NTS infection (aHR, 2.00; 95% CI, 1.35-2.97) compared with those in the control group. Stratified analyses also showed that compared with the control group, children in the appendectomy group had a higher risk of NTS infection among males (aHR, 1.60; 95% CI, 1.12-2.30), and among those living in rural areas (aHR, 1.83; 95% CI, 1.09-3.06). Overall, this study found that appendectomy among children was associated with an increased risk of NTS infection. These findings suggest the need for surveillance and preventative interventions among children following appendectomy to reduce risk of infection. A limitation of this study was potential residual confounding from risk factors such as transfusion-naive thalassemia and anemia, socioeconomic disadvantage, and household exposure, such as contaminated food or water. Future long-term studies in diverse populations should address this limitation and investigate the underlying mechanism of study findings.

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