Antibiotics alone successfully treat uncomplicated appendicitis in
children

Date:
July 27, 2020
Source:
Nationwide Children's Hospital
Summary:
Of 1,068 patients from 10 health centers enrolled in the study,
67.1% of those who elected to initially manage their care through
antibiotics alone experienced no harmful side effects and did
not later require an appendectomy by their one-year follow-up
appointment. Patients in the non-operative group experienced an
average of 6.6 disability days, compared to the 10.9 days in the
surgery group.



FULL STORY ========================================================================== Appendicitis is the most common cause for emergency abdominal surgery
in childhood, affecting 80,000 children in the United States each year,
but nonoperative treatment options are viable. A study performed by
the Midwest Pediatric Surgery Consortium, led by Peter Minneci, MD, and Katherine Deans, MD, co-founders and directors of the Center for Surgical Outcomes Research at Nationwide Children's Hospital, and published online
today in JAMA, found antibiotics alone successfully treated children with uncomplicated appendicitis and was associated with fewer disability days
at one year.


==========================================================================
Of 1,068 patients from 10 health centers enrolled in the study, 67.1%
of those who elected to initially manage their care through antibiotics
alone experienced no harmful side effects and did not later require
an appendectomy by their one-year follow-up appointment. Patients in
the non-operative group experienced an average of 6.6 disability days,
compared to the 10.9 days in the surgery group. Non-operative management
was also associated with fewer disability days for caregivers.

This research, funded by a Patient Centered Outcomes Research Institute
(PCORI) grant, expands on an initial pilot study Drs. Minneci and Deans published in 2015, which first demonstrated the efficacy and safety
of non-operative management of appendicitis in children by showing
that children who were hospitalized for uncomplicated appendicitis --
who experienced abdominal pain for no more than 48 hours, had a white
blood cell count below 18,000 and underwent an ultrasound or CT scan to
rule out rupture and to verify that their appendix was 1.1 centimeter
thick or smaller with no evidence of an abscess or fecalith -- and who
elected initially to be treated with antibiotics could be successfully
sent home without the use of traditional surgery.

"For surgery, patients need to go under general anesthesia, and there
is 1-2% chance of a major complication and 5-10% chance of a minor complication," said Dr. Minneci, principal investigator of the studies
with Dr. Deans. "And patients will definitely experience post-operative
pain and disability.

Treatment-related disability is important to kids, because it means
missing activities in their lives that may directly affect their
development and quality of life such as school, athletics and vacations." Additionally, the study, which was designed to mimic clinical practice and
used a decision aid to educate patients about the risks and benefits of
each treatment option, found that both the patients who elected to undergo surgery and those who chose nonoperative care management with antibiotics
alone had similar rates of complicated appendicitis, and reported similar health care satisfaction at 30 days and quality of life at 1 year.

Drs. Minneci and Deans said future research could study how to disseminate these results so that more patients can be informed of the two options and
the risks and benefits of each. The decision aid and treatment protocols developed for this study were developed to minimize risks and can be
easily translated into pediatric clinical practice.

"Culture change and rethinking how we treat patients is always hard,"
said Dr.

Deans. "Right now, some of the standards for success among surgeons
are different than among patients and families. Surgeons' tend to be
passionate about operations, and an appendectomy is a well-tested and
trusted procedure.

However, some patients want to avoid surgery at all costs, and the results
of our studies reflect the effectiveness of offering a non-operative
management to patients and their families in clinical practice. This
allows us to move away from a one-size-fits-all model of appendicitis
care and treat each child based on his or her values and preferences."

========================================================================== Story Source: Materials provided by Nationwide_Children's_Hospital. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Peter C. Minneci, Erinn M. Hade, Amy E. Lawrence, Yuri
V. Sebastia~o,
Jacqueline M. Saito, Grace Z. Mak, Christa Fox, Ronald B. Hirschl,
Samir Gadepalli, Michael A. Helmrath, Jonathan E. Kohler, Charles
M. Leys, Thomas T. Sato, Dave R. Lal, Matthew P. Landman, Rashmi
Kabre, Mary E.

Fallat, Jennifer N. Cooper, Katherine J. Deans. Association of
Nonoperative Management Using Antibiotic Therapy vs Laparoscopic
Appendectomy With Treatment Success and Disability Days in
Children With Uncomplicated Appendicitis. JAMA, 2020; DOI:
10.1001/jama.2020.10888 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/07/200727114735.htm

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