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Decision Making Matters in Appendicitis

Decision Making Matters in Appendicitis

Studies show that acute appendicitis accounts for more than 11% of pediatric ED admissions, and more than 70,000 children in the United States are hospitalized for it each year. Appendectomy is curative but invasive procedure that requires general anesthesia. For children, this includes perioperative risks and postoperative pain as well as disability. Research suggests that children can miss up to 2 weeks of activities after undergoing appendectomy, and their caregivers may experience similar disruptions to their normal schedules. An Alternative Approach In clinical trials, the rate of perioperative complications in patients undergoing an appendectomy for uncomplicated appendicitis ranges between 5% and 10%. Serious complications, such as reoperations or readmissions, occur in 1% to 7% of these patients. In Europe, several recent randomized clinical trials have shown that taking a non-operative management approach to appendicitis appears to be medically safe and effective in adults, with a success rate ranging between 63% and 85%. Non-operative management approaches to treat appendicitis typically involve intravenous antibiotics until symptom improvement and then a short course of oral antibiotics. “When making a treatment decision involving either a surgery or a less invasive approach, patients and families may have strong and varying treatment preferences,” explains Peter C. Minneci, MD, MHSc. “Each patient may have different risks and outcomes that are most important to them. Some may value avoiding pain and disability while others may value avoiding general anesthesia. In addition, the success of non-operative management of appendicitis may depend on the patient’s and family’s willingness to accept an ongoing risk for recurrent appendicitis. The pros and cons of these treatment options should be described to patients...
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