COLUMBUS – Families of children with uncomplicated cases of appendicitis now have the choice to treat it with antibiotics — and without surgery — at Nationwide Children’s Hospital.
Officials made the option available in response to internal hospital research published on Wednesday in the journal JAMA Surgery.
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The study, believed to be the first of its kind in the United States, found that managing appendicitis with antibiotics alone worked in 28 of 37 children, for a success rate of about 76 percent after one year.
Those patients for whom an initial regimen of antibiotics was ineffective did not have higher rates of complicated appendicitis, according to the study.
An additional 65 patients who were part of the study opted instead for immediate surgery.
The study, which enrolled children ages 7 to 17 from October 2012 through early March 2013, found that those who did not undergo surgery had faster recovery times and lower health-care costs.
Savings amounted to $810 per case, or about 16 percent less on average than patients who had their appendixes removed.
Patients eligible for the antibiotics had experienced abdominal pain for no more than 48 hours, had a white blood cell count below 18,000, underwent an ultrasound or CT scan to rule out rupture and to verify that their appendix was 1.1 centimeter thick or smaller and had no evidence of an abscess or hard stone-like piece of stool, said the study’s authors, Dr. Peter Minneci and Dr. Katherine Deans, co-directors of the Center for Surgical Outcomes Research and principal investigators in the Center for Innovation in Pediatric Practice in The Research Institute at Nationwide Children’s.
Minneci and Deans say 95 of the patients who did not undergo surgery and received IV antibiotics showed improvement and were released within 24 hours and followed a regimen of oral antibiotics for a total of 10 days.
A year after discharge, three out of four patients in the non-operative group did not have appendicitis again and have not undergone surgery, Mennici and Deans said.
Appendicitis, caused by a bacterial infection in the appendix, is the most common reason for emergency abdominal surgery in children, sending more than 70,000 young people to the operating room each year.