Nonoperative Management vs Immediate Appendectomy for Perforated Appendicitis

Abstract

Surgery| August 01 2007 Nonoperative Management vs Immediate Appendectomy for Perforated Appendicitis AAP Grand Rounds (2007) 18 (2): 19–20. https://doi.org/10.1542/gr.18-2-19 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Nonoperative Management vs Immediate Appendectomy for Perforated Appendicitis. AAP Grand Rounds August 2007; 18 (2): 19–20. https://doi.org/10.1542/gr.18-2-19 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: appendectomy, appendix rupture Source: Henry MC, Gollin G, Illam S, et al. Matched analysis of nonoperative management vs immediate appendectomy for perforated appendicitis. J Pediatr Surg. 2007,42:19–24; doi:10.1016/j.pedsurg.2006.09.005 Even in the current climate of cost containment and outcomes-based practice, there remains a striking lack of consensus regarding the treatment of many common surgical problems. The optimal treatment for children with complicated appendicitis represents an especially notable example.1,2 The effective use of new broad-spectrum antibiotics and careful patient selection has led some surgeons to advocate nonoperative management for selected patients with perforated appendicitis who do not present with clinical features requiring prompt surgical intervention: ie, are not septic, or toxic, have no evidence of small bowel obstruction, and whose pain can be controlled. Of the patients for whom medical management is an option, at this time there remains little evidence on which to choose between nonoperative versus operative management. This study from Yale University School of Medicine and four other US medical schools has sought to compare these two management options for eligible patients with perforated appendicitis who do not require immediate surgical intervention. The authors collected data from all children between 1 and 18 years of age who presented to one of four academic tertiary care children’s hospitals between May 1998 and June 2003, with a diagnosis of perforated appendicitis on the basis of preoperative CT or ultrasound, operative findings, or postoperative pathology. Cases included all patients treated nonoperatively and controls included patients treated with immediate appendectomy and matched to cases by site and clinical factors. Data were collected for 313 patients. Of the 48 patients treated nonoperatively, five (10.4%) failed medical management and required surgery within three weeks because of persistent fever, abscess, or continued and worsening symptoms. These five patients had mean hospital stays of 18 days (range 6–32 days). Of the remaining 43 patients who were successfully managed nonoperatively, 37 underwent interval appendectomy between 5 and 48 weeks following presentation. Each case was matched to four controls who had undergone immediate appendectomy. The only significant difference between the nonoperative and surgical groups was the duration of pain on presentation: the nonoperative patients had a mean duration of pain of seven days at presentation while the immediate surgical group had a mean of three days of pain at presentation. In order to match for duration of pain, a new control group was randomly generated. This control group of 48 patients was similar to the cases with regard to duration of pain and other clinical characteristics. Compared to this new group of matched controls who had undergone immediate surgery, the nonoperative group had a lower post-treatment recurrent abscess rate (4% vs 24%, P<0.1), shorter length of hospital stay (6.5 vs 8.8 days, P=.08), and fewer complications (19% vs 43%, P<.01). Dr. Cavett has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/investigative use of a commercial... You do not currently have access to this content.