Journal Article Summary

The article I chose is a multi-institutional non-randomized controlled intervention study that included 1068 children between the ages of 7-17 with uncomplicated appendicitis. The study was conducted in hospitals located across 7 US states between May 2015-October 2018. Children involved in the study were followed up at 1 year. The study investigated the association of non-operative management using antibiotic therapy versus laparoscopic appendectomy with treatment success and disability days in children with uncomplicated appendicitis. In this study, patients and their families were allowed the opportunity to choose between non-operative management with antibiotics alone or urgent laparoscopic appendectomy. Patients were enrolled in the study if uncomplicated appendicitis was confirmed by imaging whether that was US, CT, or MR which showed an appendix with a diameter of 1.1cm of less with no abscess, fecalith or phlegmon; a white blood cell count between 5,000 and 18,000; and abdominal pain for less than 48 hours prior to beginning antibiotics. Study outcomes investigated were disability days at 1 year and success of nonoperative management at 1 year. Those patients receiving non-operative management consisted of hospital admission with a minimum of 24 hours of IV antibiotics with either piperacillin-tazobactam or ciprofloxacin if there was a penicillin allergy. Diet was advanced after a minimum of 12 hours. Parenteral antibiotics were later switched to oral antibiotics. After which patients were discharged home after receiving one dose of oral antibiotics at the hospital. They were instructed to complete a course of antibiotics for 7 days. Those patients in the surgery group were admitted to the hospital with IV antibiotics (piperacillin-tazobactam, ciprofloxacin or metronidazole) and urgent laparoscopic appendectomy within 12 hours of admission. Post-op treatment included discontinuation of antibiotics, advanced diet, and discharge home once they tolerated regular diet. The study concluded that antibiotics alone had a success rate of 67.1%. The non-operative group also had significantly less disability days for both child and caregiver at 1 year compared to the surgical group.