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Interval Appendectomy Is Superior to Early Appendectomy for Complicated Appendicitis in Children
*Hale E. Wills1,2, *Robert Shirinov1,2, *Ana L. Gleisner1,2, Dennis W. Vane1,2
1Saint Louis University, Cardinal Glennon Children's Medical Center, St. Louis, MO;2Saint Louis University, St. Louis, MO
Objective To ascertain potential outcome differences for complicated appendicitis (CA) treated either with early operation (EO) or interval appendectomy (IA).
Design Criterion Standard
Setting Academic pediatric quaternary referral hospital.
Patients All patients <19 years of age preoperatively diagnosed with CA between 7/1/07 and 6/30/10.
Interventions EO (surgery performed at diagnosis) vs. IA (treatment with antibiotics followed by appendectomy several weeks later). Selection for EO vs. IA was at the surgeon’s discretion and defined by “intent to treat”.
Main Outcome Measures Complications of therapy (prolonged ileus, readmissions, surgical or radiology procedures, wound infection, post-operative abscesses [POA]).
Results Both groups were similar regarding admission age, temperature, WBC. 106 patients were diagnosed with CA. 72 underwent EO of which 24 had simple appendicitis or a normal appendix and were removed from analysis. 34 underwent IA (all imaging proven CA) of which 4 failed to complete the intended treatment course (1 failed antibiotic therapy on day three and underwent appendectomy, 1 completed antibiotic therapy but was not offered IA, 2 were lost to follow-up). There were 13 complications (27.1%,) in the remaining 48 EO children (8 POA = 16.7%); and 8 complications (26.7%) in the remaining 30 IA group (1 POA = 3.3%). Length of stay (LOS) for both groups was similar (EO = 9.79 vs. IA = 8.50 days, p = .186)
Conclusions IA improves outcome over EO for CA in children. LOS was similar although trending downward for IA. Complications, although similar in incidence, were minor (non-surgical) in the IA group as opposed to major (surgical) in the EO group. POA was higher in the EO group.
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