Nonoperative treatment of acute appendicitis in children: A feasibility study

PurposeNonoperative treatment of acute appendicitis appears to be feasible in adults. It is unclear whether the same is true for children.MethodsChildren 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.ResultsTwenty-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.ConclusionDespite 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.