Adv Pediatr Surg.  2023 Dec;29(2):65-71. 10.13029/aps.2023.29.2.65.

The Feasibility of Nonoperative Management (NOM) in Pediatric Acute Appendicitis in the Era of Coronavirus Disease-2019 (COVID-19)

• Kum HJ
• Gang S
• Kim DY

• KMID: 2551545
• DOI: http://doi.org/10.13029/aps.2023.29.2.65

Abstract

Purpose
The objective of this study, conducted at a single center, was to determine the appropriate subgroup of pediatric appendicitis patients for nonoperative management (NOM) and evaluate the effectiveness of this approach. Furthermore, the study aimed to identify the factors that influence the likelihood of treatment failure.
Methods
Out of the 37 children diagnosed with acute appendicitis who underwent NOM, 31 patients successfully completed the treatment without the need for appendectomy. However, 6 patients experienced recurrence of symptoms and subsequently required appendectomy.
Results
The two groups of patients who experienced successful NOM and those who required appendectomy did not exhibit significant differences in terms of baseline characteristics, laboratory findings, or antibiotic treatment. Furthermore, factors such as the presence of appendicolith or perforation did not demonstrate a significant association with treatment failure. Additionally, the multivariable logistic regression analysis did not identify any predictors of recurrence.
Conclusion
The study emphasizes the viability of NOM even in cases of complicated appendicitis, especially in the era of coronavirus disease 2019 limiting the chance of surgical treatment. It has shown potential in reducing the risk of complications that may arise from early surgical intervention in high-risk patients.

Keyword

Appendicitis; Conservative treatment; Outcome assessment; COVID-1; 9 Recurrence