Nonoperative treatment of acute appendicitis in children: A feasibility study.
J Pediatr Surg
; 51(1): 111-6, 2016 Jan.
Article
em En
| MEDLINE
| ID: mdl-26547287
ABSTRACT
PURPOSE:
Nonoperative treatment of acute appendicitis appears to be feasible in adults. It is unclear whether the same is true for children.METHODS:
Children 5-18 years with <48 h symptoms of acute appendicitis were offered nonoperative treatment 2 doses of piperacillin IV, then ampicillin/clavulanate ×1 week. Treatment failure (worsening on therapy) and recurrence (after completion of therapy) were noted. Patients who declined enrollment were asked to participate as controls. Cost-utility analysis was performed using Pediatric Quality of Life Scale (PedsQL®) to calculate quality-adjusted life month (QALM) for study and control patients.RESULTS:
Twenty-four patients agreed to undergo nonoperative management, and 50 acted as controls. At a mean follow-up of 14 months, three of the 24 failed on therapy, and 2/21 returned with recurrent appendicitis at 43 and 52 days, respectively. Two patients elected to undergo an interval appendectomy despite absence of symptoms. Appendectomy-free rate at one year was therefore 71% (C.I. 50-87%). No patient developed perforation or other complications. Cost-utility analysis shows a 0.007-0.03 QALM increase and a $1359 savings from $4130 to $2771 per nonoperatively treated patient.CONCLUSION:
Despite occasional late recurrences, antibiotic-only treatment of early appendicitis in children is feasible, safe, cost-effective and is experienced more favorably by patients and parents.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Apendicite
/
Ácido Penicilânico
/
Combinação Amoxicilina e Clavulanato de Potássio
/
Antibacterianos
Limite:
Adolescent
/
Child
/
Child, preschool
/
Female
/
Humans
/
Male
Idioma:
En
Revista:
J Pediatr Surg
Ano de publicação:
2016
Tipo de documento:
Article