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Published on: February 28, 2025

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Surgery or no surgery for pediatric uncomplicated appendicitis? A systematic review and meta-analysis to inform

Alyssa Stetson1, Claudia Orlas1, Raissa Li1

  • 1Pediatric Surgery Trials and Outcomes Research Center (PSTORC), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Surgery, Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA; Mass General Brigham, Mass General for Children, Boston, MA.

Surgery
|October 15, 2025
PubMed

Insights

Nonoperative management for acute uncomplicated appendicitis has a high failure rate, exceeding 20% at 1 year and 50% long-term. This approach leads to more emergency visits and readmissions compared to surgery.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Clinical Outcomes Research

Background:

  • Nonoperative management (NOM) is increasingly considered for acute uncomplicated appendicitis due to its safety.
  • Limited data on long-term failure rates of NOM hinders informed patient-clinician decision-making.

Purpose of the Study:

  • To compare the long-term failure rates of operative versus nonoperative management for acute uncomplicated appendicitis in children.
  • To evaluate secondary outcomes including emergency department visits and readmissions.

Main Methods:

  • Systematic review and meta-analysis of studies published between 2000-2024.
  • Included single- or double-arm studies on pediatric acute uncomplicated appendicitis.
  • Primary outcome: 1-year failure rate of NOM (recurrent appendicitis, surgery for pain, or interval appendectomy).

Main Results:

  • The 1-year failure rate for NOM was 22.3%, rising to 54.2% beyond 1 year.
  • Patients managed nonoperatively had higher rates of 30-day ED visits and 1-year readmissions compared to surgical management.
  • 48 studies were included in the meta-analysis.

Conclusions:

  • Nonoperative management of acute uncomplicated appendicitis demonstrates substantial long-term failure rates.
  • Patients treated nonoperatively experienced more frequent emergency department visits and readmissions.
  • Operative management remains a more reliable option for preventing recurrent appendicitis and associated healthcare utilization.
Abstract

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