After the first successful operation to treat acute appendicitis in 1759 in France and the invention of general anesthesia in 1846, appendectomy became in the 1880s one of the mainstays of treatment for appendicitis. Currently in the United States, more than 250,000 individuals undergo appendectomy, but new research may significantly reduce that number. A study published in July 2020 sought to assess the success rate and differences between standard surgical intervention and nonoperative management in pediatric patients with uncomplicated appendicitis. 

Ten teaching children’s hospitals participated in the study with standardized procedures for patient evaluation. 1068 families decided to participate and were allowed to choose between operative and nonoperative management. Families chose nonoperative management in a roughly 1:1.8 ratio. Of the 370 patients who underwent nonoperative treatment, the success rate after 1 year was determined to be 67.1% and the number of disability days for patients and caregivers was significantly lower. During initial hospitalization, the success rate of nonoperative management was 85.4%. The study also included patient/parent-reported data regarding satisfaction and quality of life. The 1-year success rate of 67.1% exceeded the threshold to determine the trial’s success by all standards except that set forth by surgeon consensus, which was decided to be 70% during trial design. 

In many aspects of medicine, we have begun straying from invasive intervention toward pharmacologic or other non-invasive solutions. For example, by controlling infection through pharmacologic means we have reduced the rate of amputations, spread of disease, and death therewith associated. We have also significantly improved recovery time for a plethora of conditions. For many working parents, this last statistic is essential to continue providing for their families. Some medical advancements may replace older methods, but so far nonoperative management of uncomplicated appendicitis does not meet this standard of success. 

By Jordan Lyons, PharmD Candidate 2020 

Full article available at: https://jamanetwork.com/journals/jama/fullarticle/2768929

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