Waiting Not Advised for Kids with Perforated Appendicitis

For children with a perforated appendix, early appendectomy appears to reduce the time away from normal activities and has fewer adverse events as compared to another common option, the interval appendectomy, which is performed several weeks after diagnosis, according to a report published the Archives of Surgery.

According to the article, appendicitis is the most common gastrointestinal condition that requires urgent surgical treatment in children in the US, with about 30% of cases being perforated appendicitis. For acute, nonperforated appendicitis, the universally accepted treatment is urgent appendectomy. But, for children with perforated appendicitis, there are two commonly used surgical treatment options: early appendectomy, in which the patient undergoes surgery within the first 24 hours of hospitalization, and interval appendectomy, in which the surgical removal of the appendix is planned for six to eight weeks after the initial diagnosis and the patient has left the hospital and returned to normal activities.

The potential advantage of the interval appendectomy, according to the authors, is to perform the operation when contamination in the abdominal cavity has resolved, potentially resulting in fewer surgical complications.

To compare the effectiveness and adverse event rates of early versus interval appendectomy, Martin L. Blakely, MD, MS, from University of Tennessee Health Science Center, and colleagues evaluated the surgical outcomes of 131 patients under the age of 18 who had a preoperative diagnosis of perforated appendicitis between October 2006 and August 2009. The patients were randomized into two groups: 64 were in the early appendectomy group and 67 were in the interval appendectomy group. The researchers used time away from normal activities and overall adverse event rates (such as intra-abdominal abscess, surgical site infection, and unplanned readmission) as the primary outcome measures.

"Early appendectomy, compared with interval appendectomy, significantly reduced the time away from normal activities” by an average of 13.8 days compared with 19.4 days, the authors reported. The overall adverse event rate was 30% compared to 55% for early versus interval appendectomy, and the total length of hospital stay also reduced by an average of more than two days for patients receiving the early appendectomy compared to those who received the interval appendectomy. A total of 23 patients in the interval group had an appendectomy earlier than planned because of failure to improve (17 patients), recurrent appendicitis (five patients), and other reasons (one patient).

"We found that those treated with early appendectomy return to normal activities an average of five days earlier. Because a child's time away from normal activities limits parents' abilities to work, we believe it is an important outcome from a patient and family perspective," the authors wrote. "The overall adverse event rate after early appendectomy was significantly lower compared with interval appendectomy.”