Five lessons in uncomplicated appendicitis: Can we remove the surgery?

Read, Andrew J.; Xu, Jane; Adams, Susan; Karpelowsky, Jonathan

doi:10.1111/jpc.13741

Cited by 3 publications

(4 citation statements)

References 40 publications

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“…Non-operative management of SAA remains a subject of debate. Success rates of up to 97% during initial treatment have been reported, but due to the high recurrence rate requiring appendectomy, the subject remains controversial [4,5]. We defined NOM failure as having This article is protected by copyright.…”

Section: Discussionmentioning

confidence: 99%

“…Success rates of up to 97% during initial treatment have been reported, but due to the high recurrence rate requiring appendectomy, the subject remains controversial. 4,5 We defined NOM failure as having to undergo a subsequent appendectomy. Here, we report a NOM failure rate of 44%, similar to previously reported studies.…”

Section: Discussionmentioning

confidence: 99%

“…However, nonoperative management (NOM) for simple acute appendicitis (SAA) is gaining popularity as an acceptable mode of treatment in healthy children [2]based on growing evidence regarding its efficacy and safety [3]. NOM is associated with an initial success rate of 92%-97% [4,5] and over 60% recurrence-free within 1 year [3,5]. A follow-up study showed that 46% of children treated with NOM will undergo an appendectomy within five years [5].…”

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confidence: 99%

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Age as an Exclusion Criterion for Nonoperative Management in Simple Acute Appendicitis in Children

Becker,

Fuhrer,

Kremer

et al. 2023

Eur J Pediatr Surg

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Aim: Non-operative management (NOM) for simple acute appendicitis (SAA) is an acceptable mode of treatment in healthy children. Previous studies of NOM routinely excluded young children (<5y), however the effect of age on NOM failure has not been directly assessed. Efficiency of NOM in young adults is questionable. Therefore, adolescents may also be at greater risk of NOM failure. Our aim was to investigate the effect of age on NOM failure. Methods: A retrospective analysis of children with SAA who received NOM between 1.1.2019-30.06.2021 at our Institution. NOM failure was defined by subsequent appendectomy. Age was assessed as a continuous variable and we also compared different age subgroups. Results: 151 children were included (60% male), mean age 11.2±3.2y (range 5-17). Overall, 66 children (44%) failed NOM, 90% of them within the first year (median 7 weeks). 10% of the cohort were <6y and 33% of them failed NOM (p=0.39). Per 1y increase in age, the odds of NOM failure increased by 12% (p=0.027). Children >14y had 2.46 times higher odds to fail NOM (p=0.03). These higher odds remained after adjusting for appendiceal diameter and appendicolith. Linear regression showed a decrease by a factor of 12 in time to NOM failure with every 1y increase in age (β=-12, p=0.09). Conclusions: The risk of NOM failure in children increases with age, therefore age should be a considered when deciding on the optimal management of SAA, especially in adolescents. Effectiveness of NOM in children younger than 6y is non-inferior to operative management and therefore should not be excluded.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Age as an Exclusion Criterion for Nonoperative Management in Simple Acute Appendicitis in Children

Becker,

Fuhrer,

Kremer

et al. 2023

Eur J Pediatr Surg

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“…Traditionally, emergent appendectomy is advocated for all patients with AA due to concerns about impending rupture. It was previously thought that inevitable uncomplicated appendicitis would inevitably progress to perforation, but recent evidence indicates AA largely exists as two separate clinical entities, i.e., uncomplicated and complicated appendicitis, with different recommended treatment regimens [ 21 , 22 ]. Emphasis must, therefore, be placed on the correct diagnosis rather than rapid diagnosis.…”

Section: Introductionmentioning

confidence: 99%

The Role of Vascular Cell Adhesion Molecule-1 (VCAM-1) in Predicting Complicated Appendicitis in Children

Lin,

Lee,

Chen

et al. 2024

Diagnostics

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Background: Acute appendicitis is a common abdominal emergency observed in emergency departments (ED). Distinguishing between uncomplicated and complicated appendicitis is important in determining a treatment strategy. Serum soluble vascular cell adhesion molecule-1 (VCAM-1) is an inflammatory biomarker. We aimed to determine the role of VCAM-1 in predicting complicated appendicitis in children. Methods: Pediatric patients with suspected appendicitis admitted to the ED were enrolled in this prospective study. Pre-surgical serum VCAM-1 was tested in children with acute appendicitis within 72 h of symptoms (from day 1 to day 3). Serum VCAM-1 levels were further analyzed and compared between patients with and without complicated appendicitis. Results: Among the 226 pediatric appendicitis patients, 70 had uncomplicated appendicitis, 138 had complicated appendicitis, and 18 had normal appendices. The mean serum VCAM-1 levels in patients with perforated appendicitis were higher than in those with simple appendicitis (p < 0.001). On day 1 to day 3, the mean VCAM-1 levels in patients with complicated appendicitis were all significantly higher than in those with uncomplicated appendicitis (all p < 0.001). Conclusion: Serum VCAM-1 levels may be helpful in differentiating uncomplicated and complicated appendicitis in children and could predict appendiceal perforation.

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A Novel Nomogram for the Differential Diagnosis Between Advanced and Early Appendicitis in Pediatric Patients

Jiang

Tang

et al. 2019

Biomark. Med.

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Aim: To develop a nomogram for differential diagnosis between advanced and early pediatric appendicitis (PA). Patients & methods: We retrospectively studied 669 PA patients. Patient characteristics and 24 serum markers were subjected to univariate and multivariate analysis, based on which the nomogram was constructed. Results: Fibrin degradation product, CRP and Na+ differed significantly between the advanced and early PA. The value of area under the receiver operating characteristic curve (AUC) was 0.8602, which was greater than that of a single serum marker. Furthermore, the nomogram showed better discriminative ability than the biomarker alone. Notably, validation indicated high stability and reproducibility. Conclusion: The nomogram is superior to the serum marker alone, and may hold promise in clinical application.

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Five lessons in uncomplicated appendicitis: Can we remove the surgery?

Cited by 3 publications

References 40 publications

Age as an Exclusion Criterion for Nonoperative Management in Simple Acute Appendicitis in Children

Age as an Exclusion Criterion for Nonoperative Management in Simple Acute Appendicitis in Children

The Role of Vascular Cell Adhesion Molecule-1 (VCAM-1) in Predicting Complicated Appendicitis in Children

A Novel Nomogram for the Differential Diagnosis Between Advanced and Early Appendicitis in Pediatric Patients

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