Nonoperative treatment of acute appendicitis in children: A feasibility study
Joseph Hartwich1, Francois I Luks1, Debra Watson-Smith1
1Division of Pediatric Surgery Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI.
Insights
Antibiotic treatment for acute appendicitis in children is feasible and safe. This approach is cost-effective, with a high success rate and favorable patient outcomes.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Health Economics
Background:
- Nonoperative management of acute appendicitis is established in adults.
- Its efficacy and safety in pediatric populations remain less understood.
Purpose of the Study:
- To evaluate the feasibility, safety, and cost-effectiveness of nonoperative antibiotic treatment for acute appendicitis in children.
- To compare outcomes and costs between nonoperative management and traditional surgical approaches.
Main Methods:
- A prospective study involving children aged 5-18 with acute appendicitis.
- Nonoperative group received intravenous piperacillin followed by oral ampicillin/clavulanate for one week.
- Control group underwent standard surgical appendectomy; cost-utility analysis used Pediatric Quality of Life Scale (PedsQL®).
Main Results:
- 24 patients received nonoperative treatment; 50 served as controls.
- Appendectomy-free rate at one year was 71%; no perforations occurred.
- Nonoperative treatment resulted in cost savings of $1359 per patient with a small increase in quality-adjusted life months.
Conclusions:
- Antibiotic-only treatment for early appendicitis in children is feasible, safe, and cost-effective.
- This approach is associated with favorable patient and parent experiences.
- Occasional late recurrences do not negate the benefits of nonoperative management.
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.
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