William Bonadio
Maimonides Medical Center, New York
Title: Management of pediatric perforated appendicitis: Comparing outcomes using early appendectomy vs. solely medical management
Biography
Biography: William Bonadio
Abstract
Background: There is controversy regarding whether children with perforated appendicitis should receive early appendectomy [EA] vs. medical management [MM] with antibiotics and delayed interval appendectomy. Objective: To compare outcomes of children with perforated appendicitis who receive EA vs. MM. Methods: Case review of consecutive children aged <18 years with perforated appendicitis who received either EA or MM during an 8-year period. Criteria for hospital discharge included patient being a febrile for at least 24 hours, pain-free and able to tolerate oral intake. Results: Of 203 patients diagnosed with perforated appendicitis, 122 received EA and 81 MM. All received parenteral antibiotic therapy initiated in the ED and continued during hospitalization. There were no significant differences between groups in mean patient age, mean CBC total WBC count, gender distribution, rates of ED fever, or rates of intra-abdominal infection [abscess or phlegmon] identified on admission. Compared to patients receiving MM, those receiving EA experienced significantly fewer: 1] days of hospitalization, parenteral antibiotic therapy and in-hospital fever; 2] radiographic studies, per-cutaneous drainage [PD] procedures, and placement of central venous catheters performed; 3] post-admission intra-abdominal complications; and 4] unscheduled repeat hospitalizations after hospital discharge. Only 1 EA-managed patient developed a post-operative wound infection. Conclusions: Children with perforated appendicitis who receive EA experience significantly less morbidity and complications vs. those receiving MM. The theoretical concern for enhanced morbidity associated with EA management of perforated appendicitis is not supported by our analysis.