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J Pediatr Surg. 2016 Jan;51(1):111-6. doi: 10.1016/j.jpedsurg.2015.10.024. Epub 2015 Oct 23.

Nonoperative treatment of acute appendicitis in children: A feasibility study.

Author information

1
Division of Pediatric Surgery Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI.
2
Division of Pediatric Surgery Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI. Electronic address: Francois_Luks@brown.edu.

Abstract

PURPOSE:

Nonoperative treatment of acute appendicitis appears to be feasible in adults. It is unclear whether the same is true for children.

METHODS:

Children 5-18 years with <48 h symptoms of acute appendicitis were offered nonoperative treatment: 2 doses of piperacillin IV, then ampicillin/clavulanate ×1 week. Treatment failure (worsening on therapy) and recurrence (after completion of therapy) were noted. Patients who declined enrollment were asked to participate as controls. Cost-utility analysis was performed using Pediatric Quality of Life Scale (PedsQL®) to calculate quality-adjusted life month (QALM) for study and control patients.

RESULTS:

Twenty-four patients agreed to undergo nonoperative management, and 50 acted as controls. At a mean follow-up of 14 months, three of the 24 failed on therapy, and 2/21 returned with recurrent appendicitis at 43 and 52 days, respectively. Two patients elected to undergo an interval appendectomy despite absence of symptoms. Appendectomy-free rate at one year was therefore 71% (C.I. 50-87%). No patient developed perforation or other complications. Cost-utility analysis shows a 0.007-0.03 QALM increase and a $1359 savings from $4130 to $2771 per nonoperatively treated patient.

CONCLUSION:

Despite occasional late recurrences, antibiotic-only treatment of early appendicitis in children is feasible, safe, cost-effective and is experienced more favorably by patients and parents.

KEYWORDS:

Antibiotics; Appendectomy; Appendicitis; Cost-utility analysis; Nonoperative treatment

PMID:
26547287
DOI:
10.1016/j.jpedsurg.2015.10.024
[Indexed for MEDLINE]

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