Early intervention for appendicitis in children

By Aimee Keenan-Greene

When it comes to children's appendectomies, early intervention significantly reduces recovery and time spent away from normal activities. 

The new non-blinded randomized study in the Archive Surgery comparing the effectiveness and adverse event rates of early and  interval appendectomy in children with perforated appendicitis, says the sooner the surgery the better for the child. 

A total of 131 patients younger than 18 years with a preoperative diagnosis of perforated appendicitis were studied.

Scientists looked at differences in 'days'  from normal activities. Secondary outcomes included the overall adverse event rates and the rate of predefined specific adverse events (intra-abdominal abscess, surgical site infection, unplanned readmission) when it came to early appendectomy (within 24 hours of admission) vs interval appendectomy (6-8 weeks after diagnosis). 

Researchers say early appendectomy, compared with interval appendectomy, significantly reduced the time away from normal activities (mean, 13.8 vs 19.4 days; P < .001). 

The overall adverse event rate was 30 percent for early appendectomy vs 55 percent for interval appendectomy (relative risk with interval appendectomy, 1.86; 95 percent confidence interval, 1.21-2.87; P = .003). 

Of the patients randomized to interval appendectomy, 23 (34 percent) had an appendectomy earlier than planned owing to failure to improve (n = 17), recurrent appendicitis (n = 5), or other reasons (n = 1).

Researchers says appendicitis is the most common gastrointestinal condition that requires urgent surgical treatment in children in the United States. Approximately 30 percent of these patients present with perforated appendicitis. The universally accepted treatment of acute, nonperforated appendicitis is urgent appendectomy. 

The optimal treatment of perforated appendicitis has two commonly used surgical treatment options: early appendectomy and interval appendectomy. Scientists say until now, there has not been an adequately powered randomized trial to compare these 2 treatment strategies.