Demographic and Clinical Characteristics Associated With the Failure of Nonoperative Management of Uncomplicated Appendicitis in Children

Abstract

Between 60 000 and 80 000 children undergo surgery for the treatment of appendicitis each year, making it the most common indication for emergency intra-abdominal surgery in the pediatric patient population.^1,2 Despite an increase in the use of laparoscopy for surgical treatment of appendicitis, between 5% and 15% of patients undergoing an appendectomy for uncomplicated appendicitis will experience at least 1 complication, with serious complications occurring for 1% to 7% of patients.^3-6 Evidence from several large trials of adults, both in the United States and Europe, has shown that treatment with antibiotics alone is a reasonable alternative to an appendectomy for select patients.^7-10 A recent multi-institutional interventional study that included more than 1000 pediatric patients demonstrated that nonoperative management with antibiotics alone is an effective strategy for treating children with uncomplicated acute appendicitis, with a 1-year success rate of 67%, no increase in complications, and fewer days lost to disability compared with surgery.¹¹