Can Appendicitis in Children Be Managed Without Surgery?

TOPLINE:

Nonoperative management of uncomplicated appendicitis in children is feasible and well tolerated, with a small proportion of patients experiencing recurrent symptoms that require appendectomy within a year; outpatient management also significantly reduces the duration of hospital stay.

METHODOLOGY:

• Researchers implemented a standardized pathway for nonoperative outpatient management of uncomplicated appendicitis in children (NOMA-C) at a university-based pediatric surgery practice.
• A total of 121 patients (mean age, 11 years) who were diagnosed with acute appendicitis between 2021 and 2023 and had no abscess were included.
• Patients who met the NOMA-C criteria were offered nonoperative outpatient management with a dose of intravenous antibiotics in the emergency department (ED) and were discharged directly from the ED if they met specific discharge criteria.
• Patients then completed a course of oral antibiotics and had planned follow-ups, including a 1-day post-discharge phone call and a 7-day post-discharge clinic visit, with additional follow-up calls at 1 month, 6 months, and 1 year.
• Patient demographics, clinical presentation, treatment details, and outcomes were extracted from the electronic medical record and analyzed.

TAKEAWAY:

• A total of 34 patients underwent nonoperative management, of whom 14 were hospitalized and 20 were discharged from the ED.
• No adverse events were reported for those who underwent nonoperative management.
• The total time spent in the hospital was significantly lower for patients who were discharged from the ED than for those who were hospitalized (7 hours vs 23 hours; P
• At the 1-year follow-up, 12% patients who were managed nonoperatively had recurrent symptoms requiring appendectomy, but none had complicated appendicitis.

IN PRACTICE:

“A protocol offering nonoperative management of appendicitis with an option for outpatient management was feasible and safe. Outpatient management was associated with shorter ED/hospital stays than those admitted,” the authors wrote.

SOURCE:

The study was led by Mary Froehlich, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas. It was published online on August 11, 2024, in the Journal of Pediatric Surgery.

LIMITATIONS:

The study was limited by a small sample size and short follow-up period, which may have affected the generalizability of the findings. The possibility of selection bias existed as patients and families had the choice to proceed with nonoperative outpatient management or inpatient observation. The study was conducted at a single institution, which may have limited the applicability to other settings.

DISCLOSURES:

The study did not receive any specific funding sources. The authors declared that they had no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.