title: Treatment of suspected acute perforated appendicitis with antibiotics and interval appendectomy.
abstract: BACKGROUND
  Initial antibiotics with planned interval appendectomy (interval AP) have been used to treat patients with complicated perforated appendicitis; however, little experience exists with this approach in children with suspected acute perforated appendicitis (SAPA). We sought to determine the outcome of initial antibiotics and interval AP in children with SAPA.
  
  
  METHODS
  Over an 18-month period, 751 consecutive patients underwent appendectomy including 105 patients with SAPA who were treated with initial intravenous antibiotics and planned interval AP ≥ 8 weeks after presentation. All SAPA patients had symptoms for ≤ 96 hours. Primary outcome variables were rates of readmission, abscess formation, and need for interval AP prior to the planned ≥ 8 weeks.
  
  
  RESULTS
  Intraabdominal abscess rate was 27%. Appendectomy prior to planned interval AP was 11% and readmission occurred in 34%. All patients underwent eventual appendectomy with pathologic confirmation confirming the previous appendiceal inflammation. White blood cell (WBC) count >15,000, WBC >15,000 plus fecalith on imaging, and WBC >15,000 plus duration of symptoms >48 hours were all significantly associated with higher rates of readmission (p=0.01, p=0.04, p=0.02) and need for interval AP prior to the planned ≥ 8 weeks (p=0.003, p=0.05, p=0.03).
  
  
  CONCLUSIONS
  Treatment of SAPA with antibiotics and planned interval AP is successful in the majority of patients; however, complications such as abscess formation and/or readmission prior to planned interval AP occur in up to one-third of patients. Certain clinical variables are associated with increased treatment complications.
authors.affiliation: Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL, USA. Electronic address: Pradeepp.nazarey@umassmemorial.org.
authors.forename: Pradeep P
authors.initials: PP
authors.lastname: Nazarey
authors.affiliation: Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL, USA; FIU College of Medicine, Miami, FL, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Stylianos
authors.affiliation: College of Health Sciences, Barry University, Miami, FL, USA.
authors.forename: Evelio
authors.initials: E
authors.lastname: Velis
authors.affiliation: Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Triana
authors.affiliation: Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Diana-Zerpa
authors.affiliation: Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Raquel
authors.initials: R
authors.lastname: Pasaron
authors.affiliation: Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Stylianos
authors.affiliation: Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Malvezzi
authors.affiliation: Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Colin
authors.initials: C
authors.lastname: Knight
authors.affiliation: Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Cathy
authors.initials: C
authors.lastname: Burnweit
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology / Q000601:surgery; D015746:Abdominal Pain / Q000209:etiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D002648:Child; D019091:Critical Pathways; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005334:Fever / Q000209:etiology; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D010359:Patient Readmission; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010538:Peritonitis / Q000188:drug therapy* / Q000209:etiology; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D011446:Prospective Studies; D013396:Suction; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin
keywords: Acute perforated appendicitis; Interval appendectomy; Nonoperative management