Antibiotics vs. appendectomy and disability days in children with appendicitis

U.S. researchers explored the efficacy of nonoperative, antibiotic management of uncomplicated appendicitis in lieu of urgent laparoscopic surgery. The non-randomized, multisite trial included 1,068 patients aged 7–17 years, who elected for one approach or the other based on family decisionmaking. A total of 806 participants had complete data and were included in the final analysis. Among 284 enrollees who chose an initial nonoperative management strategy, 67.1% still did not need appendectomy by 1-year followup in October 2019. Disability days—the study’s other main endpoint—were lower in this treatment arm, at 6.6 days compared with 10.9 days for the 522 patients in the laparoscopic appendectomy group. However, neither measurement statistically satisfied prespecified thresholds for the success rate of nonoperative management and the number of disability days; and a large number of study participants—262—were lost to followup.