title: Expanded utilization of nonoperative management for complicated appendicitis in children.
abstract: OBJECTIVE
  The initial approach to complicated appendicitis in children has become increasingly nonoperative, particularly when there is presumed perforation and a localized abscess. We extended the indications for nonoperative management to include most cases other than simple appendicitis, including those with diffuse peritoneal involvement. We evaluated outcomes and sought to identify factors at the time of hospital admission that predicted an extended length of stay (LOS) with this strategy.
  
  
  METHODS
  The records of 223 consecutive children who were managed nonoperatively for complicated appendicitis were reviewed. A conservative approach was typically pursued in those with an abscess, phlegmon, or free fluid on initial imaging studies, and diffuse tenderness, diarrhea, or significant leukocytosis after 2 days of symptoms. Interval appendectomies were performed selectively.
  
  
  RESULTS
  The average LOS was 5.6 days (1-38), but nine subjects had a LOS of greater than 14 days. Eleven (4.9 %) required appendectomy during the initial admission. Free fluid on admission imaging studies, present in 78 % of those with an extended LOS, [odds ratio (OR) 5.5], in addition to a requirement for early nasogastric drainage (OR 24.2) and a higher band count (19 vs 15 %), was significantly associated with an extended LOS.
  
  
  CONCLUSIONS
  An expansion of the indications for nonoperative management of complicated appendicitis yielded an acceptable average LOS and a low incidence of early appendectomy. However, a small subset of subjects had an extended LOS, and most of those had free peritoneal fluid on admission.
authors.affiliation: Division of Pediatric Surgery, Loma Linda University School of Medicine, 11175 Campus St, CP 21111, Loma Linda, CA 92354, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Fawley
authors.forename: Gerald
authors.initials: G
authors.lastname: Gollin
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001064:Appendicitis / Q000175:diagnosis* / Q000628:therapy*; D001774:Blood Chemical Analysis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D007507:Therapeutic Irrigation / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents