Bethell, GS; Rees, CM; Sutcliffe, J; Hall, NJ; Long, AM; Djendov, F; Emordi, V; ... Jester, I; + view all Bethell, GS; Rees, CM; Sutcliffe, J; Hall, NJ; Long, AM; Djendov, F; Emordi, V; Peter, M; Staight, S; Jackson, A; Cleeve, S; Kelay, A; Terry, M; Major, C; Croysdale, O; Patel, B; Nelson, M; Cusick, E; Rhodes, H; King, J; Lewis, S; Driver, C; Winter, G; Wilson, M; Robertson, R; Rutherford, D; McGivern, K; Jafarli, I; Curkovic, S; Jackson, R; Jadhav, B; Conroy, M; Raymond, T; Gangalam, V; Selvakumar, D; Elmalik, K; Habak, R; Abdullah, M; Osama, MA; Gopal, M; Phillips, L; Asanai, K; Gabra, H; Naidoo, K; Zafar, N; Lewis, S; Kashora, F; Thakrar, D; Rex, D; Budzanowski, A; Binnington, J; Timbrell, S; Ridgeway, M; Chan, S; Asour, A; Aderombi, A; Kocsis, AM; Menzies, D; Murtada, A; Dragu, C; Quan, V; Askari, A; Patel, K; Zuberi, S; Ebrahim, S; McHoney, M; Patel, H; Hotonu, S; Meikle, A; Dass, R; Beamish, A; Codd, R; Ooi, R; Tang, A; Taylor, L; Belgaumkar, A; Oyewole, B; Narayan, P; Hollyman, M; Kosti, A; Badenoch, T; Rakin, A; Khan, H; Goulder, F; Siggens, K; Peters, K; Kirkham-Wilson, F; Bowyer, S; Jamnadass, E; Froggatt, P; Lai, K; Navarro, C; Chandrabose, D; Awolaran, O; Toh, S; Darbyshire, A; Towers, A; Tan, C; Miles, J; Jester, I; - view fewer (2023) Outcomes 1 year after non-operative management of uncomplicated appendicitis in children: Children with AppendicitiS during the CoronAvirus panDEmic (CASCADE) study. BJS Open , 7 (3) , Article zrad055. 10.1093/bjsopen/zrad055.

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Abstract

BACKGROUND: A major shift in treatment of appendicitis occurred early in the SARS-CoV-2 pandemic with non-operative management used commonly outside research protocols and in units with limited previous experience. This study aims to compare real-world outcomes of surgery versus non-operative management of uncomplicated appendicitis in children with 1-year follow-up. METHOD: A prospective multicentre observational study of children treated for uncomplicated appendicitis at 74 hospitals in the UK and Ireland from 1 April to 31 July 2020 was performed. Propensity-score matched analysis was conducted using age, sex, C-reactive protein at diagnosis and duration of symptoms as covariates. Primary outcomes were success of non-operative management defined as achieving 1-year follow-up without undergoing appendicectomy due to recurrent appendicitis or ongoing symptoms, and occurrence of any predefined complication (intra-abdominal collection, wound infection, bowel obstruction or reintervention). RESULTS: Of 1464 children with presumed uncomplicated appendicitis, 1027 (70.2 per cent) underwent surgery and 437 (29.9 per cent) underwent non-operative management. Ninety-four children (21.5 per cent) treated by initial non-operative management required appendicectomy during the index hospital admission while recurrent appendicitis after discharge occurred in 25 (10.4 per cent) children within 1 year. The overall success rate of non-operative management at 1 year was 63.1 per cent (95 per cent c.i. 58.0 to 68.3 per cent). For propensity-score matched analyses, 688 children undergoing surgery and 307 undergoing non-operative management were included. Any predefined complication occurred in 50 (7.3 per cent) children undergoing surgery and in four (1.3 per cent) children undergoing non-operative management (OR 5.9 (95 per cent c.i. 2.1 to 16.6)) in the propensity-score matched cohort. There was no mortality or stoma formation. CONCLUSION: Non-operative management is a safe and valid alternative to appendicectomy in children with uncomplicated appendicitis.

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