title: Early vs interval appendectomy for children with perforated appendicitis.
abstract: OBJECTIVE
  To compare the effectiveness and adverse event rates of early vs interval appendectomy in children with perforated appendicitis.
  
  
  METHODS
  Nonblinded randomized trial.
  
  
  METHODS
  A tertiary-referral urban children's hospital.
  
  
  METHODS
  A total of 131 patients younger than 18 years with a preoperative diagnosis of perforated appendicitis.
  
  
  METHODS
  Early appendectomy (within 24 hours of admission) vs interval appendectomy (6-8 weeks after diagnosis).
  
  
  METHODS
  Time away from normal activities (days). Secondary outcomes included the overall adverse event rates and the rate of predefined specific adverse events (eg, intra-abdominal abscess, surgical site infection, unplanned readmission).
  
  
  RESULTS
  Early appendectomy, compared with interval appendectomy, significantly reduced the time away from normal activities (mean, 13.8 vs 19.4 days; P < .001). The overall adverse event rate was 30% for early appendectomy vs 55% for interval appendectomy (relative risk with interval appendectomy, 1.86; 95% confidence interval, 1.21-2.87; P = .003). Of the patients randomized to interval appendectomy, 23 (34%) had an appendectomy earlier than planned owing to failure to improve (n = 17), recurrent appendicitis (n = 5), or other reasons (n = 1).
  
  
  CONCLUSIONS
  Early appendectomy significantly reduced the time away from normal activities. The overall adverse event rate after early appendectomy was significantly lower compared with interval appendectomy.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00435032.
authors.affiliation: Division of Pediatric Surgery, University of Tennessee Health Science Center, Memphis, TN 38111, USA. mblakely@uthsc.edu
authors.forename: Martin L
authors.initials: ML
authors.lastname: Blakely
authors.forename: Regan
authors.initials: R
authors.lastname: Williams
authors.forename: Melvin S
authors.initials: MS
authors.lastname: Dassinger
authors.forename: James W
authors.initials: JW
authors.lastname: Eubanks
authors.forename: Peter
authors.initials: P
authors.lastname: Fischer
authors.forename: Eunice Y
authors.initials: EY
authors.lastname: Huang
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Paton
authors.forename: Barbara
authors.initials: B
authors.lastname: Culbreath
authors.forename: Allison
authors.initials: A
authors.lastname: Hester
authors.forename: Christian
authors.initials: C
authors.lastname: Streck
authors.forename: S Douglas
authors.initials: SD
authors.lastname: Hixson
authors.forename: Max R
authors.initials: MR
authors.lastname: Langham
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000009:adverse effects; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D020127:Recovery of Function; D013997:Time Factors