Management of Simple Appendicitis in Children: Early Appendectomy vs. Non-operative Management With Subsequent...

Non-operative management (NOM) for simple acute appendicitis is an acceptable alternative to surgery, yet concerns regarding late failure and safety of subsequent appendectomy persist. The risks and complications of appendectomy following failed NOM are not widely reported. This study compares outcomes of early appendectomy and appendectomy after NOM failure in children.

A retrospective cohort study of 136 children aged 5-18 years diagnosed with simple acute appendicitis between 2019 and 2021. Upon initial diagnosis, parents chose between early appendectomy and NOM. Group A included children undergoing early appendectomy (n = 91). Group B included children with failed NOM requiring subsequent appendectomy (n = 45).

Age and gender were comparable between the groups (p > 0.05). Group A had significantly higher odds of post-operative complications compared to Group B (OR = 3.03, p = 0.036). Mean post-operative hospital stay was one day shorter in Group B (p = 0.004). Post-operative emergency department (ED) visits and readmissions were slightly lower in group B (A = 14 % vs. B = 4 %, p = 0.085 and A = 8 % vs. B = 0 %, p = 0.056, respectively). As expected, Group B required longer total antibiotic therapy (intravenous and oral) (diff = 10.8 days, p < 0.001) and more imaging studies (diff = 1.1, p < 0.001).

Appendectomy following NOM failure in children with appendicitis resulted in fewer post-operative complications and shorter post-operative hospitalizations compared to early appendectomy. Our findings suggest that NOM may be a safe and viable initial management strategy for children with simple appendicitis, as appendectomy is safe for those who complete the initial NOM protocol and will eventually require an appendectomy.

Retrospective cohort study.

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