title: Management of Pediatric Perforated Appendicitis: Comparing Outcomes Using Early Appendectomy Versus Solely Medical Management.
abstract: BACKGROUND
  There is controversy regarding whether children with perforated appendicitis should receive early appendectomy (EA) versus medical management (MM) with antibiotics and delayed interval appendectomy. The objective of this study was to compare outcomes of children with perforated appendicitis who receive EA versus MM.
  
  
  METHODS
  Case review of consecutive children <18 years of age with perforated appendicitis who received either EA or MM during an 8-year period. Criteria for hospital discharge included patient being afebrile for at least 24 hours, pain-free and able to tolerate oral intake.
  
  
  RESULTS
  Of 203 patients diagnosed with perforated appendicitis, 122 received EA and 81 received MM. All received parenteral antibiotic therapy initiated in the emergency department and continued during hospitalization. There were no significant differences between groups in mean patient age, mean complete blood count total white blood cells count, gender distribution, rates of emergency department fever or rates of intra-abdominal infection (abscess or phlegmon) identified on admission. Compared with patients receiving MM, those receiving EA experienced significantly fewer (1) days of hospitalization, parenteral antibiotic therapy and in-hospital fever; (2) radiographic studies, percutaneous drainage procedures and placement of central venous catheters performed; (3) post admission intra-abdominal complications and (4) unscheduled repeat hospitalizations after hospital discharge. Only 1 EA-managed patient developed a postoperative wound infection.
  
  
  CONCLUSIONS
  Children with perforated appendicitis who receive EA experience significantly less morbidity and complications versus those receiving MM. The theoretical concern for enhanced morbidity associated with EA management of perforated appendicitis is not supported by our analysis.
authors.affiliation: From the Maimonides Medical Center, Brooklyn, New York.
authors.forename: William
authors.initials: W
authors.lastname: Bonadio
authors.forename: Katie
authors.initials: K
authors.lastname: Rebillot
authors.forename: Onyinyechi
authors.initials: O
authors.lastname: Ukwuoma
authors.forename: Christine
authors.initials: C
authors.lastname: Saracino
authors.forename: Arthur
authors.initials: A
authors.lastname: Iskhakov
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000453:epidemiology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents