Systematic Review and Meta-analysis to Compare the Short- and Long-term Outcomes of Non-operative Management With Early Operative Management of Simple Appendicitis in Children After the COVID-19 Pandemic.
J Pediatr Surg
; 59(6): 1050-1057, 2024 Jun.
Article
em En
| MEDLINE
| ID: mdl-38158255
ABSTRACT
BACKGROUND:
Non-operative management (NOM) of simple appendicitis is becoming an increasingly researched treatment option. This systematic review aims to describe the short and long-term failure rates of NOM and the complication rate of appendicectomy in children with simple appendicitis.METHODS:
The systematic review was registered a priori (CRD42022322149). Study inclusion criteria are participants aged ≤ 18 years of age; groups undergoing both NOM and appendicectomy for simple appendicitis; outcomes including one or more of NOM failure rate at 30 days or 1 year and beyond; studydesign:
RCT or case control study. Four databases were searched and 3 reviewers determined study eligibility and data extraction. Risk of bias was assessed and meta-analysis was performed using Stata.RESULTS:
The database search identified 2731 articles, 14 studies met the inclusion criteria; 4 RCTs and 10 case controlled studies. All studies had moderate-serious risk of bias. There were no deaths in either group in any study. Meta-analysis demonstrated a 30 day failure rate of 20 % (95 % CI 11-29 %) and 11 studies reported failure rate at 1 year or beyond at 32 % (95 % CI 25-38 %). Rates of significant complications of appendicectomy was 1 % (95 % CI 0-1 %).CONCLUSIONS:
Non-operative management of simple appendicitis in children is safe, with moderate early success. The failure rate increases over time, resulting in eventual appendicectomy in a third of the children diagnosed with appendicitis. These data will enable clinicians to have an informed discussion with children and their parents about their treatment options for simple appendicitis. LEVEL OF EVIDENCE II.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Contexto em Saúde:
2_ODS3
/
4_TD
/
6_ODS3_enfermedades_notrasmisibles
Problema de saúde:
2_muertes_prevenibles
/
4_covid_19
/
6_digestive_diseases
Assunto principal:
Apendicectomia
/
Apendicite
/
COVID-19
Tipo de estudo:
Systematic_reviews
Limite:
Child
/
Humans
Idioma:
En
Revista:
J Pediatr Surg
/
J. pediatr. surg
/
Journal of pediatric surgery
Ano de publicação:
2024
Tipo de documento:
Article