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Association of nonoperative management using antibiotic therapy vs laparoscopic appendectomy with treatment success and disability days in children with uncomplicated appendicitis

JAMA Aug 14, 2020

Minneci PC, Hade EM, Lawrence AE, et al. - Researchers conducted this multi-institutional nonrandomized controlled intervention study to analyze the success rate of nonoperative management and to compare variations in treatment-related disability, satisfaction, health-related quality of life, and complications between nonoperative management and surgery in children with uncomplicated appendicitis. The sample consisted of 1,068 children (median age, 12.4 years; 38% girls) aged 7 through 17 years with uncomplicated appendicitis treated at 10 tertiary children’s hospitals across 7 US states between May 2015 and October 2018 with 1-year follow-up through October 2019. For children with uncomplicated appendicitis, an initial nonoperative management strategy with antibiotics alone had a success rate of 67.1% and was correlated with statistically significantly fewer disability days at 1 year compared with urgent surgery. Substantial losses to follow-up, however, were not statistically significant in accordance with the predetermined threshold for an acceptable success rate of nonoperative management, and the estimated gap in disability days was not reached.

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