Intermediate-term evaluation of interval appendectomy in the pediatric population
Yunfei Zhang1, Qin Deng1, Hai Zhu1
1Department of Pediatric General Surgery and Liver Transplantation, Childrens Hospital, Chongqing Medical University, 136 Zhongshan 2nd Rd., Chongqing, 400014, People's Republic of China.
Insights
Initial non-operative therapy followed by interval appendectomy is a safe and effective treatment for complicated appendicitis in children, reducing long-term complications like bowel obstruction.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Clinical Outcomes Research
Background:
- Complicated appendicitis management in children often involves initial non-operative therapy.
- Long-term effectiveness of interval appendectomy after non-operative management is not well-defined.
- This study evaluates long-term outcomes of interval appendectomy versus emergency appendectomy.
Purpose of the Study:
- To compare the long-term effectiveness of initial non-operative therapy with interval appendectomy versus emergency appendectomy in children with complicated appendicitis.
- To assess short- and long-term postoperative complications, including adhesive small bowel obstruction.
- To determine the optimal initial management strategy for pediatric complicated appendicitis.
Main Methods:
- Retrospective review of pediatric patients with complicated appendicitis (2010-2017).
- Comparison between initial non-operative therapy (n=471) and emergency appendectomy (n=377).
- Propensity score matching used to create comparable groups (n=348) for outcome analysis.
Main Results:
- No significant differences in baseline characteristics except symptom duration.
- Emergency appendectomy group had higher American Society of Anesthesiology (ASA) scores.
- Initial non-operative therapy group showed lower rates of surgical wound infection and postoperative peritonitis/abscess.
- Adhesive small bowel obstruction incidence was significantly lower in the initial non-operative therapy group.
Conclusions:
- Initial non-operative therapy followed by interval appendectomy is a feasible approach for pediatric complicated appendicitis.
- This strategy offers advantages in reducing postoperative complications, particularly long-term obstruction events.
- Initial non-operative therapy with interval appendectomy should be considered a primary treatment option for pediatric complicated appendicitis.
Background:
Initial non-operative management of children with complicated appendicitis has been well studied but when comparing emergency procedures the long-term effectiveness of interval appendectomy remains undefined. This study aimed to determine the effects of interval appendectomy from the perspective of long-term follow-up.
Methods:
A retrospective review of patients with complicated appendicitis between 2010 and 2017 was performed. The medical records of 471 patients with initial non-operative therapy and 377 patients treated with emergency appendectomy who served as controls were reviewed. Propensity score matching was performed to adjust for any potential selection bias in the two strategies. A comparison of the clinical outcomes, including short- and long-term postoperative complications, was conducted in the 348 matched patients.
Results:
On presentation, there were no differences in age, weight, sex distribution, white blood cell (WBC), or procalcitonin (PCT) between the two groups, except for days of symptoms. The patients undergoing emergency appendectomy had a high American Society of Anesthesiology (ASA) score (p = 0.002). The patients who underwent initial non-operative therapy had a lower complication rate, including surgical wound infection [odds ratio (OR), 3.77; 95% CI 2.59-5.50; p < 0.001) and postoperative peritonitis or abscess (OR, 3.81; 95% CI 1.79-8.12; p < 0.001) than those who underwent emergency appendectomy. Furthermore, the incidence of adhesive small bowel obstruction (ASBO) was lower in patients who underwent initial non-operative therapy than in patients who underwent emergency appendectomy (OR, 4.6; 95% CI 0.99-21.41; p = 0.032).
Conclusions:
Initial non-operative therapy with interval appendectomy was feasible for most patients with appendiceal abscesses and had advantages in terms of postoperative complications, especially regarding long-term obstruction events. Therefore, initial non-operative therapy with interval appendectomy should be considered the first treatment of choice for pediatric patients with complicated appendicitis.
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