title: Matched analysis of nonoperative management vs immediate appendectomy for perforated appendicitis.
abstract: BACKGROUND
  The role of nonoperative therapy vs immediate appendectomy in the management of children with perforated appendicitis remains undefined. The objective of this study was to rigorously compare these management options in groups of patients with matched clinical characteristics.
  
  
  METHODS
  Multicenter case-control study was conducted from 1998 to 2003. We compared patients treated nonoperatively vs those undergoing appendectomy to identify differences in 12 clinical parameters. We then generated a second control group of patients matched for these variables and compared the following outcomes in these clinically similar groups: complication rate, abscess rate, and length of stay (LOS). Analysis was performed according to intention-to-treat principles, using chi2, Fisher exact, and Student t tests.
  
  
  RESULTS
  The only significant difference between patients treated nonoperatively and those treated by appendectomy was the duration of pain on presentation (6.8 vs 3.1 days of pain). We created a second control group of patients undergoing immediate appendectomy matched on duration of pain on presentation to patients treated nonoperatively. These groups continued to be clinically comparable for the other 11 parameters. Compared to this matched control group, the nonoperative group had fewer complications (19% vs 43%, P < .01), fewer abscesses (4% vs 24%, P < .01), and a trend for shorter LOS (6.5 +/- 5.7 vs 8.8 +/- 6.7 days, P = .08).
  
  
  CONCLUSIONS
  When nonoperative management for perforated appendicitis was studied using appropriately matched clinical controls, we found that it resulted in a lower complication rate and shorter LOS in the subset of patients presenting with a long duration of pain. Our data suggest that nonoperative management should be prospectively evaluated in children with perforated appendicitis presenting with a history of pain exceeding 5 days.
authors.affiliation: Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Marion C W
authors.initials: MC
authors.lastname: Henry
authors.forename: Gerald
authors.initials: G
authors.lastname: Gollin
authors.forename: Saleem
authors.initials: S
authors.lastname: Islam
authors.forename: Karl
authors.initials: K
authors.lastname: Sylvester
authors.forename: Angela
authors.initials: A
authors.lastname: Walker
authors.forename: Bonnie L
authors.initials: BL
authors.lastname: Silverman
authors.forename: R Lawrence
authors.initials: RL
authors.lastname: Moss
mesh_terms: D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000601:surgery* / Q000628:therapy; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male