Vitality

For Mild Appendicitis, Sending Kids Home With Antibiotics Might Be Safer And Cheaper Than Surgery

Bottle of pills
A new study reaffirms allowing children to avoid surgery in lieu of antibiotics for cases of mild appendicitis. me and the sysop, CC BY-ND 2.0

In what’s sure to be bad news for children who love free ice cream and weeks off from school, a new study published Wednesday in JAMA Surgery reaffirms a wait-and-see strategy for cases of mild appendicitis.

Studying 102 children with uncomplicated appendicitis, the authors found that, on average, those families who had chosen antibiotic therapy and observation over an appendectomy paid less in medical bills, and the children suffered less sick days. Altogether, though 25 percent of the nonsurgery group eventually required an operation by a year’s time, there was no difference in the rate of worsening appendicitis nor in the overall quality of life between either group.

“When chosen by the family, nonoperative management with antibiotics alone is an effective treatment strategy for children with uncomplicated appendicitis,” the authors reported. “It incurs less morbidity and lower costs than surgery.”

As noted by the researchers, previous randomized trials have found that a course of antibiotics can be a relatively effective option over surgery for children with uncomplicated appendicitis, defined simply as an infected appendix that hasn’t burst or progressed too severely. The success rate of avoiding surgery has ranged from 66 to 85 percent in these studies. For this latest study, the authors wanted to see if allowing the parents to choose for themselves, after proper counseling on the risks of either option, would still reap benefits in the long run.

Recruiting children (ages 7 to 17) who had only presented signs of appendicitis for two days or less as a precaution, the authors were eventually left with 37 children whose parents had chosen antibiotics compared to 65 who went the surgery route. Those in the former group were given antibiotics via an IV, and if they improved within a day, were allowed to resume their treatment at home. They were then followed up at home two to five days later, then two weeks, then a month, six months, and finally a year.

Though nine children ultimately needed an operation to remove their appendix (two within a month), there were no additional complications from the surgery afterward, compared to five children in the surgery group, including two who needed to be readmitted to the hospital, and one who required another operation.

In addition to the savings in both medical bills (an average of $710) and sick days, the researchers note that allowing parents to choose what they’d like for their children carries its own rewards over simply dictating one option or other to them.

“For families who do not want to accept the risk of recurrent appendicitis, nonoperative management may potentially harm the child,” they explained. “For example, if a family is so afraid of a recurrence that they visit the emergency department every time their child has abdominal pain, then their child will likely undergo increased imaging and will eventually undergo an appendectomy. In this case, letting them choose an appendectomy up front may be the better choice for that child.”

Approximately 70,000 children are hospitalized for appendicitis every year, and though surgery is highly effective, it can cause children to miss up to two weeks of school and/or normal activities.

“Treatment of several inflammatory intra-abdominal diseases has changed from primarily surgical management to initial medical management, with patients who fail medical management subsequently undergoing surgery,” the authors concluded. “Based on our study and those reported in the literature, treatment of uncomplicated appendicitis appears to be similar.”

Source: Minneci P, Mahida J, Lodwick D, et al. Effectiveness of Patient Choice in Nonoperative vs Surgical Management of Pediatric Uncomplicated Acute Appendicitis. JAMA Surgery. 2015.

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