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When Avoiding Surgery Is Riskier in Pediatric Uncomplicated Appendicitis

Debate continues on the issue of antibiotics vs. surgery in acute uncomplicated appendicitis in children, with a new analysis offering a twist.

The review, published online by JAMA Pediatrics, involved 404 patients across several studies, concluding that antibiotic treatment was riskier in children with appendicolith, a calcified mass in the appendix. On the other hand, the Sichuan University researchers found that antibiotics-only treatment for pediatric patients with uncomplicated appendicitis appeared to work well and present few safety issues.

Background information in the study points out that although acute appendicitis is among the most common pediatric emergencies, it presents differently in children than adults and complicates treatment decisions. Avoiding surgery with antibiotic treatment tends to be more widely accepted in adults with an uncomplicated appendicitis diagnosis.

For this study, measured outcomes included the following:

  • success rate of antibiotic treatment and appendectomy
  • complications
  • readmissions
  • length of stay
  • total cost
  • disability days

With data independently assessed by two reviewers, five studies ultimately were included in the meta-analysis: 168 of the patients between 5 and 15 years old were in the antibiotic treatment group and 236 were in the appendectomy group.

Avoiding surgery was deemed effective in 90.5% of patients. As for the other children, 11 of the 16 patients in the antibiotic-only group underwent an appendectomy within 48 hours, and the remaining five had another appendicitis flare-up within a month.

Subgroup analysis showed, however, that treatment failure risk was heightened in patients with appendicolith, citing a Mantel-Haenszel fixed-effects risk ratio of 10.43.

Study authors cautioned that the research was limited in that it included only one randomized clinical trial, as well as four other cohort studies.

The meta-analysis shows that treating pediatric patients with uncomplicated appendicitis initially with antibiotics may be effective without increasing the risk of complications, the researchers concluded. However, the failure rate is higher than for appendectomy, they noted, because surgery is preferable for uncomplicated appendicitis with appendicolith.