Researchers evaluated data from five pertinent studies involving 442 children with uncomplicated appendicitis, 189 treated conservatively with antibiotics and 253 who underwent appendectomies. Their data were published online, August 17, in Archives of Disease in Childhood.
Treatment efficacy – defined as resolution of acute appendicitis without complications – was significantlygreater among surgically treated than conservatively treated patients (98% vs.74%; relative risk, 0.77). Surgery outperformed conservative treatment in all five studies.
Conservatively treated patients were also about 7 times more likely to be rehospitalized, and their outcomes were especially poor relative to surgery if they had fecoliths.Conservatively treated patients without fecoliths had a trend toward fewer complications, a trend toward increased efficacy, and a lower readmission rate, compared to conservatively treated patients with fecoliths. Nonetheless, the conservative approach in patients without a fecolith remained inferior to surgery, in terms of both treatment efficacy and readmission risk.