Validation of Nonselective Conservative Treatment for Pediatric Acute Appendicitis

This study aimed to validate our therapeutic strategy for the nonselective conservative treatment of pediatric acute appendicitis.

This single-center retrospective comparative study was conducted using the data of 368 patients with acute appendicitis. Two therapeutic strategies were compared: emergent open appendectomy (early group, n = 138 patients; 2007-2011) and conservative antibiotic treatment (late group, n = 230; 2012-2023). Both strategies were nonselectively applied, regardless of the degree of disease progression.

None of the patients in the late group required admission to the intensive care unit or experienced mortality. Compared with the early group, the late group had a significantly longer duration of hospitalization (5 vs. 7 days; p = 0.0017) and a higher rate of non-planned readmission after initial admission (2% vs. 13%; p = 0.0004). Surgery was performed on a nonworking day for 26% of patients and at night for 59% of patients in the early group. However, subsequent interval appendectomy for patients in the late group was not performed on a nonworking day or at night.

Nonselective conservative treatment with antibiotics was safe for managing acute appendicitis in children and eliminated the need for surgery at night and during nonworking days, despite longer duration of the initial hospitalization and the higher rate of readmission.