Background: Acute appendicitis (AA) is a common pediatric surgical emergency with considerable financial implications. Data on the comparative outcomes of surgical and conservative management approaches and their impact on healthcare resources are limited.
Objectives: This retrospective study aimed to compare surgical and conservative management outcomes of AA in an Israeli level 1 surgical center, focusing upon length of pediatric emergency department (PED) stay, hospital stay, revisit and readmission rates, and rates of eventual surgical intervention. The number of sick days needed by the child and caregiver during the first year post-diagnosis was also quantified.
Methods: Consecutive pediatric patients (<18 years of age) diagnosed with AA in our PED between August 2016 and February 2022 were included. Data on demographics, clinical examinations, outcomes, and resource utilization were collected. Patients with complicated appendicitis or severe chronic diseases were excluded.
Results: The 418 suitable patients were divided between 86 in the conservative management group and 332 in the surgical management group. Conservatively managed patients had longer-lasting PED visits, more PED revisits, more readmissions, and more ambulatory visits, resulting in more "sick days". Fifty (58%) of them eventually required surgery. Age ≥11 years emerged as an independent predictor for conservative treatment failure.
Conclusion: Conservative management of AA imposed a greater burden on PED resources. Despite similar initial lengths of PED stays, conservatively managed children had more numerous and longer-lasting readmissions. Surgical management was associated with relatively more favorable outcomes, reduction in healthcare resources utilization, and lower treatment failure rates. Age >11 years emerged as a predictor for conservative treatment failure. These findings warrant larger-scale studies to enhance treatment strategies and use of healthcare resources for children with AA. Hospital policies should take this data into account when deciding on protocols for appendicitis treatment.