title: A systematic review and individual patient data meta-analysis of published randomized clinical trials comparing early versus interval appendectomy for children with perforated appendicitis.
abstract: OBJECTIVE
  Our objective was to perform a meta-analysis on RCTs that compared outcomes in children with perforated appendicitis (PA) who underwent either early appendectomy (EA) or interval appendectomy (IA). We also sought to determine if the presence of an intra-abdominal abscess (IAA) at admission impacted treatment strategy and outcomes.
  
  
  METHODS
  We identified two RCTs comparing EA versus IA in children with PA. A meta-analysis was performed using regression models and the overall adverse event rate was analyzed. The treatment effect variation depending on the presence of IAA at admission was also evaluated.
  
  
  RESULTS
  EA significantly reduced the odds of an adverse event (OR 0.28, 95 % CI 0.1-0.77) and an unplanned readmission (OR 0.08, 95 % CI 0.01-0.67), as well as the total charges (79 % of the IA, 95 % CI 63-100) for those who did not have an IAA at admission. In children with an IAA, there was no difference between EA and IA. However, heterogeneity of treatment effect was present regarding IAA at presentation.
  
  
  CONCLUSIONS
  While EA appears to improve outcomes in patients without an abscess, the published data support no significant difference in outcomes between EA and IA in patients with an abscess.
authors.affiliation: Department of Pediatric Surgery, Vanderbilt University Medical Center, 2200 Childrens Way, DOT 7100, Nashville, TN, 37232, USA.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Duggan
authors.affiliation: Department of Pediatric Surgery, Vanderbilt University Medical Center, 2200 Childrens Way, DOT 7100, Nashville, TN, 37232, USA.
authors.forename: Andre P
authors.initials: AP
authors.lastname: Marshall
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA.
authors.forename: Katrina L
authors.initials: KL
authors.lastname: Weaver
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA. sspeter@cmh.edu.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.affiliation: Department of Pediatric Surgery, Vanderbilt University Medical Center, 2200 Childrens Way, DOT 7100, Nashville, TN, 37232, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Tice
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Leena
authors.initials: L
authors.lastname: Choi
authors.affiliation: Department of Pediatric Surgery, Vanderbilt University Medical Center, 2200 Childrens Way, DOT 7100, Nashville, TN, 37232, USA. Martin.blakely@vanderbilt.edu.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Blakely
mesh_terms: D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D006801:Humans; D008499:Medical Records; D016032:Randomized Controlled Trials as Topic; D012422:Rupture, Spontaneous; D013997:Time Factors
keywords: Children; Interval appendectomy; Intra-abdominal abscess; Perforated appendicitis