Comparison of conservative and operative treatment of uncomplicated appendicitis in the pediatric population

Abstract

Introduction/Objective. Studies about possibilities of conservative, i.e., non-operative management of acute uncomplicated appendicitis in adult and pediatric population have been published lately, considering benefits of preserving appendix and potential complications related to appendectomy. Methods. In this retrospective study, medical data of 76 patients treated at the Institute for Child and Youth Health Care of Vojvodina in Novi Sad for acute uncomplicated appendicitis in 2015 and 2016 have been analyzed, comparing length of stay, antibiotic therapy use, complications occurrence, as well as the financial burden depending of the type of therapy applied. Results. During this period, 76 patients (55 operated on and 21 treated conservatively) were treated for acute uncomplicated appendicitis. Conservatively treated children spent statistically significantly shorter period of time at the hospital compared to the ones operated on (4.24 vs. 5.76 days; p < 0.001). Early surgical complications occurred in 10.91% of those operated on and in 9.52% conservatively treated children, which was not a statistically significant difference (p = 0.863). The total cost of hospital stay was significantly lower in those who underwent non-operative management (10,340 RSD vs. 54,281 RSD; p < 0.001). The difference was significant even when analyzing costs related to rehospitalization and operative treatment of children initially treated conservatively (p < 0.001). Conclusion. Non-operative, i.e., conservative treatment of acute uncomplicated appendicitis in the pediatric population is safe and effective compared to the operative one, and it is not associated with more frequent occurrence of early surgical complications. Total costs for the non-operative treatment are significantly lower, even considering costs related to re-hospitalization of children initially treated conservatively.