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A systematic review and individual patient data meta-analysis of published randomized clinical trials comparing early
Eileen M Duggan1, Andre P Marshall1, Katrina L Weaver2
1Department of Pediatric Surgery, Vanderbilt University Medical Center, 2200 Childrens Way, DOT 7100, Nashville, TN, 37232, USA.
Insights
Early appendectomy (EA) may improve outcomes for children with perforated appendicitis (PA) but not if an intra-abdominal abscess (IAA) is present. This meta-analysis compared EA versus interval appendectomy (IA) in pediatric PA.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Evidence-Based Medicine
Background:
- Perforated appendicitis (PA) is a common surgical emergency in children.
- Treatment strategies include early appendectomy (EA) and interval appendectomy (IA), particularly when an intra-abdominal abscess (IAA) is present.
Purpose of the Study:
- To conduct a meta-analysis of randomized controlled trials (RCTs) comparing EA and IA in children with PA.
- To evaluate the impact of IAA on treatment strategy and outcomes.
Main Methods:
- Meta-analysis of two RCTs comparing EA versus IA in pediatric PA.
- Analysis of overall adverse event rates and treatment effect variation based on IAA presence.
Main Results:
- EA significantly reduced adverse events and unplanned readmissions in children without IAA.
- EA also reduced total charges for children without IAA.
- No significant difference in outcomes was observed between EA and IA in children with IAA.
Conclusions:
- EA may offer benefits for children with PA but without IAA.
- Current evidence suggests no significant difference between EA and IA for children with PA and IAA.
Purpose:
Our objective was to perform a meta-analysis on RCTs that compared outcomes in children with perforated appendicitis (PA) who underwent either early appendectomy (EA) or interval appendectomy (IA). We also sought to determine if the presence of an intra-abdominal abscess (IAA) at admission impacted treatment strategy and outcomes.
Methods:
We identified two RCTs comparing EA versus IA in children with PA. A meta-analysis was performed using regression models and the overall adverse event rate was analyzed. The treatment effect variation depending on the presence of IAA at admission was also evaluated.
Results:
EA significantly reduced the odds of an adverse event (OR 0.28, 95 % CI 0.1-0.77) and an unplanned readmission (OR 0.08, 95 % CI 0.01-0.67), as well as the total charges (79 % of the IA, 95 % CI 63-100) for those who did not have an IAA at admission. In children with an IAA, there was no difference between EA and IA. However, heterogeneity of treatment effect was present regarding IAA at presentation.
Conclusions:
While EA appears to improve outcomes in patients without an abscess, the published data support no significant difference in outcomes between EA and IA in patients with an abscess.
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