New research demonstrates that nonoperative management of uncomplicated appendicitis is a safe and effective option in a variety of health care systems.
Appendicitis is the most common cause for emergency abdominal surgery in childhood, affecting 80,000 children in the United States each year, but nonoperative treatment options are viable. A study performed by the Midwest Pediatric Surgery Consortium, led by Peter Minneci, MD, and Katherine Deans, MD, co-founders and directors of the Center for Surgical Outcomes Research at Nationwide Children’s Hospital, found that nonoperative management of uncomplicated appendicitis is a safe and effective option in a variety of health care systems.
Of 1,068 patients from 10 health centers enrolled in the study, 67.1% of those who elected to initially manage their care through antibiotics alone experienced no harmful side effects and did not later require an appendectomy by their one-year follow-up. Patients in this group experienced an average of 6.6 disability days, compared to the 10.9 days in the surgery group.
Nonoperative management was also associated with fewer disability days for caregivers.
“With surgery, patients will definitely experience postoperative pain and disability,” says Dr. Minneci, principal investigator of the studies with Dr. Deans. “Treatment-related disability is important to kids, because it means missing activities in their lives that may directly affect their development and quality of life such as school, athletics and vacations," Dr. Deans notes.
Additionally, the study, which focused on children who were hospitalized for uncomplicated appendicitis — who experienced abdominal pain for no more than 48 hours, had a white blood cell count below 18,000 and underwent an ultrasound or CT scan to rule out rupture and to verify that their appendix was 1.1 centimeter thick or smaller with no evidence of an abscess or fecalith — found that both the patients who elected to undergo surgery and those who chose nonoperative management with antibiotics alone reported similar health care satisfaction at 30 days and quality of life at 1 year.
Drs. Minneci and Deans say that future research could study how to disseminate these results and translate them into pediatric clinical practice so that more patients can be informed of the two options and the risks and benefits of each.
“Culture change and rethinking how we treat patients is always hard,” says Dr. Deans. “Surgeons tend to be passionate about operations, and an appendectomy is a well-tested and trusted procedure. However, some patients want to avoid surgery at all costs, and the results of our study allows us to move away from a one-size-fits-all model of appendicitis care and treat each child based on his or her values and preferences.”