Early vs Interval Appendectomy for Children With Perforated Appendicitis

Abstract

Setting: A tertiary-referral urban children's hospital.Patients: A total of 131 patients younger than 18 years with a preoperative diagnosis of perforated appendicitis.Interventions: Early appendectomy (within 24 hours of admission) vs interval appendectomy (6-8 weeks after diagnosis).Main Outcome Measures: Time away from normal activities (days). Secondary outcomes included the overall adverse event rates and the rate of predefined specific adverse events (eg, intra-abdominal abscess, surgical site infection, unplanned readmission).Results: Early appendectomy, compared with interval appendectomy, significantly reduced the time away from normal activities (mean, 13.8 vs 19.4 days; PϽ.001). The overall adverse event rate was 30% for early appendectomy vs 55% for interval appendectomy (relative risk with interval appendectomy, 1.86; 95% confidence interval, 1.21-2.87; P=.003). Of the patients randomized to interval appendectomy, 23 (34%) had an appendectomy earlier than planned owing to failure to improve (n=17), recurrent appendicitis (n=5), or other reasons (n=1). Conclusions:Early appendectomy significantly reduced the time away from normal activities. The overall adverse event rate after early appendectomy was significantly lower compared with interval appendectomy.

Development and validation of an ultrasound scoring system for children with suspected acute appendicitis

“…This differentiation has clinical implications, as new data suggest that antibiotic therapy alone may be adequate treatment for nonperforated appendicitis in children [22]. As a randomized trial found that nonoperative management of perforated appendicitis with an associated phlegmon in children results in worse outcomes than primary operative management, the ability to distinguish simple from perforated appendicitis is critical if practice patterns eventually trend away from operative management of simple appendicitis [23].…”

Prospective Evaluation of a Clinical Pathway for Suspected Appendicitis

“…3,4 Early diagnosis of appendicitis is important because of the increased morbidity, mortality, and costs associated with perforated appendicitis. 5,6 Although there is no diagnostic gold standard for appendicitis, 2 grading scores, the Alvarado and Samuel' s pediatric appendicitis score (PAS), have been developed to aid accurate diagnosis of appendicitis. 1,[7][8][9] The PAS is a score that was first reported by Samuel in Journal of Pediatric Surgery in 2002.…”

“Perforated Appendicitis In Children”

“…The risk of perforation is highest in the first 4 years of life and was reported in more than 70% of children in this age group. By comparison, the rate of perforation in adolescents is 10-20% reported by the authors [15,16].…”

“…Later appendectomy patients stayed in the hospital two days longer, and 87 percent received a central venous catheter, compared with only 44 percent of patients who had the early operation. Of all patients who received catheters, 43 percent of later appendectomy patients were discharged with it, compared with only 9 percent of early appendectomy patients by [16].…”

“…The overall adverse event rate was 30% for early appendectomy vs. 55% for interval appendectomy (relative risk with interval appendectomy, 1.86; 95% confidence interval, 1.21-2.87; P = .003). Of the patients randomized to interval appendectomy, 23 (34%) had an appendectomy earlier than planned owing to failure to improve (n = 17), recurrent appendicitis (n = 5), or other reasons (n = 1) was observed by the author [16].…”