Nonoperative treatment of acute appendicitis in children: A feasibility study

Joseph Hartwich, Francois I. Luks, Debra Watson-Smith, Arlet G. Kurkchubasche, Christopher S. Muratore, Hale E. Wills, Thomas Tracy

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Purpose Nonoperative treatment of acute appendicitis appears to be feasible in adults. It is unclear whether the same is true for children. Methods Children 5-18 years with < 48 h symptoms of acute appendicitis were offered nonoperative treatment: 2 doses of piperacillin IV, then ampicillin/clavulanate × 1 week. Treatment failure (worsening on therapy) and recurrence (after completion of therapy) were noted. Patients who declined enrollment were asked to participate as controls. Cost-utility analysis was performed using Pediatric Quality of Life Scale (PedsQL®) to calculate quality-adjusted life month (QALM) for study and control patients. Results Twenty-four patients agreed to undergo nonoperative management, and 50 acted as controls. At a mean follow-up of 14 months, three of the 24 failed on therapy, and 2/21 returned with recurrent appendicitis at 43 and 52 days, respectively. Two patients elected to undergo an interval appendectomy despite absence of symptoms. Appendectomy-free rate at one year was therefore 71% (C.I. 50-87%). No patient developed perforation or other complications. Cost-utility analysis shows a 0.007-0.03 QALM increase and a $1359 savings from $4130 to $2771 per nonoperatively treated patient. Conclusion Despite occasional late recurrences, antibiotic-only treatment of early appendicitis in children is feasible, safe, cost-effective and is experienced more favorably by patients and parents.

Original languageEnglish (US)
Pages (from-to)111-116
Number of pages6
JournalJournal of pediatric surgery
Volume51
Issue number1
DOIs
StatePublished - Jan 1 2016

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Appendicitis
Feasibility Studies
Appendectomy
Quality of Life
Therapeutics
Cost-Benefit Analysis
Recurrence
Clavulanic Acid
Piperacillin
Ampicillin
Treatment Failure
Parents
Pediatrics
Anti-Bacterial Agents
Costs and Cost Analysis

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Hartwich, J., Luks, F. I., Watson-Smith, D., Kurkchubasche, A. G., Muratore, C. S., Wills, H. E., & Tracy, T. (2016). Nonoperative treatment of acute appendicitis in children: A feasibility study. Journal of pediatric surgery, 51(1), 111-116. https://doi.org/10.1016/j.jpedsurg.2015.10.024
Hartwich, Joseph ; Luks, Francois I. ; Watson-Smith, Debra ; Kurkchubasche, Arlet G. ; Muratore, Christopher S. ; Wills, Hale E. ; Tracy, Thomas. / Nonoperative treatment of acute appendicitis in children : A feasibility study. In: Journal of pediatric surgery. 2016 ; Vol. 51, No. 1. pp. 111-116.
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abstract = "Purpose Nonoperative treatment of acute appendicitis appears to be feasible in adults. It is unclear whether the same is true for children. Methods Children 5-18 years with < 48 h symptoms of acute appendicitis were offered nonoperative treatment: 2 doses of piperacillin IV, then ampicillin/clavulanate × 1 week. Treatment failure (worsening on therapy) and recurrence (after completion of therapy) were noted. Patients who declined enrollment were asked to participate as controls. Cost-utility analysis was performed using Pediatric Quality of Life Scale (PedsQL{\circledR}) to calculate quality-adjusted life month (QALM) for study and control patients. Results Twenty-four patients agreed to undergo nonoperative management, and 50 acted as controls. At a mean follow-up of 14 months, three of the 24 failed on therapy, and 2/21 returned with recurrent appendicitis at 43 and 52 days, respectively. Two patients elected to undergo an interval appendectomy despite absence of symptoms. Appendectomy-free rate at one year was therefore 71{\%} (C.I. 50-87{\%}). No patient developed perforation or other complications. Cost-utility analysis shows a 0.007-0.03 QALM increase and a $1359 savings from $4130 to $2771 per nonoperatively treated patient. Conclusion Despite occasional late recurrences, antibiotic-only treatment of early appendicitis in children is feasible, safe, cost-effective and is experienced more favorably by patients and parents.",
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Hartwich, J, Luks, FI, Watson-Smith, D, Kurkchubasche, AG, Muratore, CS, Wills, HE & Tracy, T 2016, 'Nonoperative treatment of acute appendicitis in children: A feasibility study', Journal of pediatric surgery, vol. 51, no. 1, pp. 111-116. https://doi.org/10.1016/j.jpedsurg.2015.10.024

Nonoperative treatment of acute appendicitis in children : A feasibility study. / Hartwich, Joseph; Luks, Francois I.; Watson-Smith, Debra; Kurkchubasche, Arlet G.; Muratore, Christopher S.; Wills, Hale E.; Tracy, Thomas.

In: Journal of pediatric surgery, Vol. 51, No. 1, 01.01.2016, p. 111-116.

Research output: Contribution to journalArticle

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AU - Hartwich, Joseph

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AU - Muratore, Christopher S.

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N2 - Purpose Nonoperative treatment of acute appendicitis appears to be feasible in adults. It is unclear whether the same is true for children. Methods Children 5-18 years with < 48 h symptoms of acute appendicitis were offered nonoperative treatment: 2 doses of piperacillin IV, then ampicillin/clavulanate × 1 week. Treatment failure (worsening on therapy) and recurrence (after completion of therapy) were noted. Patients who declined enrollment were asked to participate as controls. Cost-utility analysis was performed using Pediatric Quality of Life Scale (PedsQL®) to calculate quality-adjusted life month (QALM) for study and control patients. Results Twenty-four patients agreed to undergo nonoperative management, and 50 acted as controls. At a mean follow-up of 14 months, three of the 24 failed on therapy, and 2/21 returned with recurrent appendicitis at 43 and 52 days, respectively. Two patients elected to undergo an interval appendectomy despite absence of symptoms. Appendectomy-free rate at one year was therefore 71% (C.I. 50-87%). No patient developed perforation or other complications. Cost-utility analysis shows a 0.007-0.03 QALM increase and a $1359 savings from $4130 to $2771 per nonoperatively treated patient. Conclusion Despite occasional late recurrences, antibiotic-only treatment of early appendicitis in children is feasible, safe, cost-effective and is experienced more favorably by patients and parents.

AB - Purpose Nonoperative treatment of acute appendicitis appears to be feasible in adults. It is unclear whether the same is true for children. Methods Children 5-18 years with < 48 h symptoms of acute appendicitis were offered nonoperative treatment: 2 doses of piperacillin IV, then ampicillin/clavulanate × 1 week. Treatment failure (worsening on therapy) and recurrence (after completion of therapy) were noted. Patients who declined enrollment were asked to participate as controls. Cost-utility analysis was performed using Pediatric Quality of Life Scale (PedsQL®) to calculate quality-adjusted life month (QALM) for study and control patients. Results Twenty-four patients agreed to undergo nonoperative management, and 50 acted as controls. At a mean follow-up of 14 months, three of the 24 failed on therapy, and 2/21 returned with recurrent appendicitis at 43 and 52 days, respectively. Two patients elected to undergo an interval appendectomy despite absence of symptoms. Appendectomy-free rate at one year was therefore 71% (C.I. 50-87%). No patient developed perforation or other complications. Cost-utility analysis shows a 0.007-0.03 QALM increase and a $1359 savings from $4130 to $2771 per nonoperatively treated patient. Conclusion Despite occasional late recurrences, antibiotic-only treatment of early appendicitis in children is feasible, safe, cost-effective and is experienced more favorably by patients and parents.

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Hartwich J, Luks FI, Watson-Smith D, Kurkchubasche AG, Muratore CS, Wills HE et al. Nonoperative treatment of acute appendicitis in children: A feasibility study. Journal of pediatric surgery. 2016 Jan 1;51(1):111-116. https://doi.org/10.1016/j.jpedsurg.2015.10.024