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November 27, 2024 – Treating children with uncomplicated appendicitis using antibiotics alone is a safe and cost-saving alternative to surgery, according to a recent study published in the Journal of the American College of Surgeons.
Appendicitis is a leading cause of hospitalizations in children in the U.S., with appendectomy being the most common surgical procedure for this condition, according to the National Institutes of Health. While appendectomy has been the standard treatment, researchers have been exploring nonoperative management, which involves administering antibiotics intravenously, as a viable alternative.
The study, led by Dr. Peter C. Minneci, chair of the Department of Surgery at Nemours Children’s Health in Wilmington, Delaware, highlights that nonoperative management not only provides a safe treatment option but also proves to be cost-effective over a one-year period.
Study Findings
The research analyzed data from 1,068 patients aged 7 to 17 treated for uncomplicated appendicitis at children’s hospitals in the Midwest between 2015 and 2018. Families were offered two options: antibiotics alone or urgent laparoscopic appendectomy. Of these, 370 patients chose antibiotics-only treatment, while 698 underwent surgery.
The study revealed that:
- The average cost of treatment with antibiotics alone was $8,044, compared to $9,791 for laparoscopic appendectomy.
- Quality-adjusted life year (QALY) scores, which measure health outcomes, were slightly higher for antibiotics-only treatment (0.895) than for surgery (0.884).
- Nonoperative management was both less expensive and more effective in terms of health-related quality of life, even when considering disability days and alternative cost calculations.
Implications for Pediatric Care
“These findings demonstrate that antibiotics-only treatment is not only safe but also cost-effective for managing pediatric uncomplicated appendicitis,” said Dr. Minneci. “This approach provides families with a reasonable alternative to surgery, offering a less invasive option with lower costs and favorable outcomes.”
The study also evaluated patient-reported outcomes, such as health-related quality of life and recovery time, over a one-year follow-up period. Children treated with antibiotics generally reported fewer days off school and lower pain levels compared to those who underwent surgery.
Future Research Directions
Despite its promising results, the study has limitations. Researchers noted that the findings are based on data from children’s hospitals in the Midwest and may not be generalizable to all populations. The study also focused on a one-year follow-up period, leaving room for questions about long-term outcomes.
Next steps include examining outpatient nonoperative management and same-day discharge after laparoscopic appendectomy to better understand their cost-effectiveness and rates of treatment failure.
This study adds to the growing body of evidence supporting nonoperative management as a viable alternative to surgery for children with uncomplicated appendicitis, offering both clinical and financial benefits to families and healthcare systems alike.
Reference:
Lindsay A. Gil et al., Cost-Effectiveness of Nonoperative Management vs Upfront Laparoscopic Appendectomy for Pediatric Uncomplicated Appendicitis Over 1 Year, Journal of the American College of Surgeons (2024). DOI: 10.1097/XCS.0000000000001232
