Outcomes of Nonoperative Management of Uncomplicated Appendicitis

被引:32
作者
Bachur, Richard G.
Lipsett, Susan C.
Monuteaux, Michael C.
机构
[1] Boston Childrens Hosp, Div Emergency Med, Boston, MA USA
[2] Harvard Med Sch, Boston, MA USA
关键词
RANDOMIZED-CONTROLLED-TRIAL; OPEN APPENDECTOMY; ANTIBIOTIC-THERAPY; PERFORATED APPENDICITIS; INTERVAL APPENDECTOMY; COMPLICATED APPENDICITIS; SUSPECTED APPENDICITIS; CLAVULANIC-ACID; CLINICAL-TRIAL; CHILDREN;
D O I
10.1542/peds.2017-0048
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
BACKGROUND AND OBJECTIVES: Nonoperative management (NOM) of uncomplicated pediatric appendicitis has promise but remains poorly studied. NOM may lead to an increase in resource utilization. Our objective was to investigate the trends in NOM for uncomplicated appendicitis and study the relevant clinical outcomes including subsequent appendectomy, complications, and resource utilization. METHODS: Retrospective analysis of administrative data from 45 US pediatric hospitals. Patients <19 years of age presenting to the emergency department (ED) with appendicitis between 2010 and 2016 were studied. NOM was defined by an ED visit for uncomplicated appendicitis treated with antibiotics and the absence of appendectomy at the index encounter. The main outcomes included trends in NOM among children with uncomplicated appendicitis and frequency of subsequent diagnostic imaging, ED visits, hospitalizations, and appendectomy during 12-month follow-up. RESULTS: 99 001 children with appendicitis were identified, with a median age of 10.9 years. Sixty-six percent were diagnosed with nonperforated appendicitis, of which 4190 (6%) were managed nonoperatively. An increasing number of nonoperative cases were observed over 6 years (absolute difference, +20.4%). During the 12-month follow-up period, NOM patients were more likely to have the following: advanced imaging (+8.9% [95% confidence interval (Cl) 7.6% to 10.3%]), ED visits (+11.2% [95% CI 9.3% to 13.2%]), and hospitalizations (+43.7% [95% CI 41.7% to 45.8%]). Among patients managed nonoperatively, 46% had a subsequent appendectomy. CONCLUSIONS: A significant increase in NOM of nonperforated appendicitis was observed over 6 years. Patients with NOM had more subsequent ED visits and hospitalizations compared with those managed operatively at the index visit. A substantial proportion of patients initially managed nonoperatively eventually had an appendectomy.
引用
收藏
页数:10
相关论文
共 48 条
[1]   Nonoperative treatment of acute appendicitis in children [J].
Abes, Musa ;
Petik, Buelent ;
Kazil, Selcuk .
JOURNAL OF PEDIATRIC SURGERY, 2007, 42 (08) :1439-1442
[2]   Non-operative management of early, acute appendicitis in children: Is it safe and effective? [J].
Armstrong, Jeff ;
Merritt, Neil ;
Jones, Sarah ;
Scott, Leslie ;
Buetter, Andreana .
JOURNAL OF PEDIATRIC SURGERY, 2014, 49 (05) :782-785
[3]   Laparoscopic versus open appendectomy in children - A meta-analysis [J].
Aziz, O ;
Athanasiou, T ;
Tekkis, PP ;
Purkayastha, S ;
Haddow, J ;
Malinovski, V ;
Paraskeva, P ;
Darzi, A .
ANNALS OF SURGERY, 2006, 243 (01) :17-27
[4]   Effect of Reduction in the Use of Computed Tomography on Clinical Outcomes of Appendicitis [J].
Bachur, Richard G. ;
Levy, Jason A. ;
Callahan, Michael J. ;
Rangel, Shawn J. ;
Monuteaux, Michael C. .
JAMA PEDIATRICS, 2015, 169 (08) :755-760
[5]   Contemporary Review of Risk-Stratified Management in Acute Uncomplicated and Complicated Diverticulitis [J].
Boermeester, Marja A. ;
Humes, David J. ;
Velmahos, George C. ;
Soreide, Kjetil .
WORLD JOURNAL OF SURGERY, 2016, 40 (10) :2537-2545
[6]   Delaying Appendectomy Does Not Lead to Higher Rates of Surgical Site Infections A Multi-institutional Analysis of Children With Appendicitis [J].
Boomer, Laura A. ;
Cooper, Jennifer N. ;
Anandalwar, Seema ;
Fallon, Sara Childress ;
Ostlie, Daniel ;
Leys, Charles M. ;
Rangel, Shawn ;
Mattei, Peter ;
Sharp, Susan W. ;
St Peter, Shawn D. ;
Rodriguez, J. Ruben ;
Kenney, Brian ;
Besner, Gail E. ;
Deans, Katherine J. ;
Minneci, Peter C. .
ANNALS OF SURGERY, 2016, 264 (01) :164-168
[7]   Nonoperative treatment of suspected appendicitis in remote medical care environments: Implications for future spaceflight medical care [J].
Campbell, MR ;
Johnston, SL ;
Marshburn, T ;
Kane, J ;
Lugg, D .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2004, 198 (05) :822-830
[8]   Acute appendicitis in children: not only surgical treatment [J].
Caruso, Anna Maria ;
Pane, Alessandro ;
Garau, Roberto ;
Atzori, Pietro ;
Podda, Marcello ;
Casuccio, Alessandra ;
Mascia, Luigi .
JOURNAL OF PEDIATRIC SURGERY, 2017, 52 (03) :444-448
[9]   Evidence-based adjustment of antibiotic in pediatric complicated appendicitis in the era of antibiotic resistance [J].
Chan, Kin Wai Edwin ;
Lee, Kim Hung ;
Mou, Jennifer Wai Cheung ;
Cheung, Sing Tak ;
Sihoe, Jennifer Dart Yin ;
Tam, Yuk Him .
PEDIATRIC SURGERY INTERNATIONAL, 2010, 26 (02) :157-160
[10]  
Coldrey E., 1959, J_Int Coll Surg, V32, P255