For children with uncomplicated appendicitis, the success rate of initial treatment with antibiotics is unlikely to differ by age and other factors, according to a planned secondary analysis of a study investigating nonoperative management and surgery for children with uncomplicated appendicitis.
“Initial treatment with antibiotics alone is a reasonable option for children presenting with uncomplicated appendicitis,” Dr. Peter Minneci of the Center for Surgical Outcomes Research at Nationwide Children’s Hospital, in Columbus, Ohio, and colleagues, write in JAMA.
In a recent study, they found that nonoperative management was successful in 67 percent of children at one year and led to fewer disability days compared with laparoscopic appendectomy.
However, reported differences in outcomes by age, race/ethnicity, family income and transfer status led them to investigate whether primary outcomes of that study varied in subgroups.
Among the 1,068 enrolled patients, 370 were managed with antibiotics and 698 had appendectomy. Complete follow-up data at one year was available for about three-quarters of the children in both groups.
At one year, the success rate of nonoperative management 63.8 percent in children aged 10 years and younger and 68.1 percent of patients older than age 10 (P=0.47), the researchers report.
Nonoperative management was successful at one year in 65.9 percent of patients with household incomes below $50,000 and 68.3 percent with household above this level, and in 68.3 percent of patients presenting directly to the treating hospital and 65.6 percent of transferred patients.
There were no significant between-group differences in days of disability by age, income or transfer status, sex, race/ethnicity, insurance status, primary caregiver education level or primary language.
“It was important to do the subgroup analysis to see if the associated outcomes and the risks and benefits of these treatment options differed based on measurable clinical or socioeconomic characteristics,” Dr. Minneci told Reuters Health by email.
“What the study results showed is that the outcomes and risks and benefits associated with surgery or nonoperative management of appendicitis did not differ based on any of the measurable characteristics including age, sex, race/ethnicity, household income, insurance status, education level, or transfer status. Therefore, both treatments should be considered for all eligible patients regardless of those characteristics,” Dr. Minneci said.