No significant differences were identified between nonoperative management and surgery for children with uncomplicated appendicitis in disability days and success rate of nonoperative management at 1 year, according to the results of a secondary analysis published in JAMA.

In this nonrandomized, multi-institutional study, 1068 children aged 7 to 17 years with uncomplicated appendicitis were enrolled from May 2015 to October 2018; 370 underwent nonoperative management and 698 underwent appendectomy. Primary outcomes of the study were the number of disability days the patients experienced and success rate of nonoperative management at 1 year.

The cohort was stratified according to the following for subgroup analyses: age (10 years and younger vs older than 10 years); annual household income (less than $50,000 vs $50,000 or more); and transfer status.


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At 1 year, success of nonoperative management at 1 year was achieved by 63.8% of those participants up to and including age 10 years vs 68.1% for those older than 10 years (P =.47); 65.9% for those with a household income of less than $50,000 vs 68.3% for those with a household income of $50,000 or more (P =.70); and 68.3% for those not transferred vs 65.6% for those who were transferred (P =.60).

There were no significant differences in number of disability days experienced by the patients:  6.3 days with nonoperative management in patients aged 10 years and younger vs 10.3 days with surgery (95% CI, -6.8 to -1.2), and 6.6 days with nonoperative management in patients older than 10 years vs 10.9 days with surgery (95% CI, -6.0 to -2.7; P =.82); 7.1 days with nonoperative management in patients with an annual household income less than $50,000 vs 10.9 days with surgery (95% CI, 6.2 to -1.4), and 5.8 days with nonoperative management in patients with an annual household income of $50,000 and more vs 9.6 days with surgery (95% CI, -5.4 to -2.2; P =.99); and 6.8 days with nonoperative management in patients who were not transferred vs 11.3 days with surgery (95% CI, -6.3 to -2.6), and 6.3 days with nonoperative management in patients who were transferred vs 10.3 days with surgery (95% CI, -6.3 to -1.9; P =.87).

“The success rate of nonoperative management and its association with fewer disability days than surgery for uncomplicated appendicitis in children did not differ by age, household income, or transfer status. However, the prespecified 70% success rate threshold for nonoperative management was not met for most subgroups,” the study authors concluded.

Reference

Minneci PC, Hade EM, Metzger GA, Saito JM, Mak GZ, Deans KJ; Midwest Pediatric Surgery Consortium. Association of initial treatment with antibiotics vs surgery with treatment success and disability in subgroups of children with uncomplicated appendicitis. JAMA. 325(24):2502-2504. doi:10.1001/jama.2021.6710

This article originally appeared on Infectious Disease Advisor