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Objective: To examine impact on family of immediate appendectomy compared to initial non-operative management for perforated appendicitis in children.
Design: Prospective cohort study.
Setting: Tertiary-referral urban children’s hospital.
Patients: Sixty-six prospectively-identified families of children treated for perforated appendicitis between June 2009 and May 2010.
Interventions: Parents completed 1) a daily activity journal documenting the number of missed school and employment days from the time of presentation through the completion of therapy; and 2) the Impact on Family Scale (IFS) at presentation and at completion of therapy.
Main Outcome Measures: Missed school and employment days were compared using Mann-Whitney U-tests. IFS total scores were compared using repeated-measures ANOVA. Hospital length of stay (LOS), antibiotic duration, and frequency of adverse events were compared using Student t-test and Fisher’s exact test.
Results: There were no significant differences in post-operative surgical site infections or number of missed school or employment days between the two groups. The initial non-operative management group (n=26) had a longer median hospital LOS (P<.01) and median total time on antibiotics (P<.01) compared to the immediate appendectomy group (n=40). IFS total scores decreased over time (signifying less family impact) for both treatment groups, but this difference was significant only in the initial non-operative management group (P<.01).
Conclusions: Immediate appendectomy or initial non-operative management can effectively manage perforated appendicitis in children. Despite an increased hospital length of stay for the initial non-operative management group, there were no significant differences in the number of missed school or employment days compared to the immediate appendectomy group. Greater improvements in family impact are associated with initial non-operative management as measured by the IFS at completion of therapy.