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At the Cutting Edge of Non-Operative Management of Appendicitis

May 6, 2022

In 2017, Bachur et al published a study analyzing outcomes of non-operative management of uncomplicated appendicitis (NOM) in 45 children’s hospitals in the US. This study reported an increase in NOM over a 6-year period and noted that 46% of these patients went on to have an appendectomy within the next year. This month, a new study (10.1542/peds.2021-054693) from this research team at Boston Children’s hospital (with an additional author) describes 9 years’ worth of appendicitis data from 47 children’s hospitals from the Pediatric Health Information Systems (PHIS) database. The authors identified 117,705 children under 19 years of age with appendicitis and compares outcomes between those who received immediate surgery and those who opted for NOM.

Their updated results continue to show an increasing number of children and families who received NOM (10,394 of 73,544 patients). 1- and 5-year failure rates (i.e., surgery required) were 18.6% and 23.3%, respectively. Among those without perforation initially, those who failed NOM, were more likely to have subsequent perforation than those who received surgery (45.7% versus 37.5%). 

What is the role of NOM given the risk of failure and subsequent perforation? To help answer that question, we invited Dr. Charles Snyder (pediatric surgeon at Children’s Mercy Hospital in Kansas City) to provide a commentary (10.1542/peds.2021-056034). Dr. Snyder notes the strengths and limitations of the study and previews multi-institutional randomized trials to determine the role of NOM. While the Bachur et al study suggests significant failure rates and complications, it also suggests that for most, NOM might be beneficial. What do you prefer for your patients—surgery or NOM? Link to this article and commentary and see if your opinion changes based on the results and analysis provided.

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