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Outcomes 1 year after non-operative management of uncomplicated appendicitis in children: the Children with AppendicitiS during the CoronAvirus panDEmic (CASCADE) study

Outcomes 1 year after non-operative management of uncomplicated appendicitis in children: the Children with AppendicitiS during the CoronAvirus panDEmic (CASCADE) study
Outcomes 1 year after non-operative management of uncomplicated appendicitis in children: the Children with AppendicitiS during the CoronAvirus panDEmic (CASCADE) study
Background: A major shift in treatment of appendicitis occurred early in the SARS-CoV-2 pandemic with non-operative management used commonly outside research protocols and in units with limited previous experience. This study aims to compare real-world outcomes of surgery versus non-operative management of uncomplicated appendicitis in children with 1-year follow-up.

Method: A prospective multicentre observational study of children treated for uncomplicated appendicitis at 74 hospitals in the UK and Ireland from 1 April to 31 July 2020 was performed. Propensity-score matched analysis was conducted using age, sex, C-reactive protein at diagnosis and duration of symptoms as covariates. Primary outcomes were success of non-operative management defined as achieving 1-year follow-up without undergoing appendicectomy due to recurrent appendicitis or ongoing symptoms, and occurrence of any predefined complication (intra-abdominal collection, wound infection, bowel obstruction or reintervention).

Results: Of 1464 children with presumed uncomplicated appendicitis, 1027 (70.2 per cent) underwent surgery and 437 (29.9 per cent) underwent non-operative management. Ninety-four children (21.5 per cent) treated by initial non-operative management required appendicectomy during the index hospital admission while recurrent appendicitis after discharge occurred in 25 (10.4 per cent) children within 1 year. The overall success rate of non-operative management at 1 year was 63.1 per cent (95 per cent c.i. 58.0 to 68.3 per cent). For propensity-score matched analyses, 688 children undergoing surgery and 307 undergoing non-operative management were included. Any predefined complication occurred in 50 (7.3 per cent) children undergoing surgery and in four (1.3 per cent) children undergoing non-operative management (OR 5.9 (95 per cent c.i. 2.1 to 16.6)) in the propensity-score matched cohort. There was no mortality or stoma formation.

Conclusion: Non-operative management is a safe and valid alternative to appendicectomy in children with uncomplicated appendicitis.





2474-9842
Bethell, George
c7a62cc1-5573-41f6-ae00-3c11e8219dd4
Rees, Clare M
31441171-e830-4234-97e7-9db0deff9615
Sutcliffe, Jonathan
ed9e10c6-9f1f-4008-b0a3-6299feb36cc1
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
CASCADE study collaborators
Bethell, George
c7a62cc1-5573-41f6-ae00-3c11e8219dd4
Rees, Clare M
31441171-e830-4234-97e7-9db0deff9615
Sutcliffe, Jonathan
ed9e10c6-9f1f-4008-b0a3-6299feb36cc1
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf

Bethell, George, Rees, Clare M, Sutcliffe, Jonathan and Hall, Nigel , CASCADE study collaborators (2023) Outcomes 1 year after non-operative management of uncomplicated appendicitis in children: the Children with AppendicitiS during the CoronAvirus panDEmic (CASCADE) study. BJS Open, 7 (3), [zrad055]. (doi:10.1093/bjsopen/zrad055).

Record type: Article

Abstract

Background: A major shift in treatment of appendicitis occurred early in the SARS-CoV-2 pandemic with non-operative management used commonly outside research protocols and in units with limited previous experience. This study aims to compare real-world outcomes of surgery versus non-operative management of uncomplicated appendicitis in children with 1-year follow-up.

Method: A prospective multicentre observational study of children treated for uncomplicated appendicitis at 74 hospitals in the UK and Ireland from 1 April to 31 July 2020 was performed. Propensity-score matched analysis was conducted using age, sex, C-reactive protein at diagnosis and duration of symptoms as covariates. Primary outcomes were success of non-operative management defined as achieving 1-year follow-up without undergoing appendicectomy due to recurrent appendicitis or ongoing symptoms, and occurrence of any predefined complication (intra-abdominal collection, wound infection, bowel obstruction or reintervention).

Results: Of 1464 children with presumed uncomplicated appendicitis, 1027 (70.2 per cent) underwent surgery and 437 (29.9 per cent) underwent non-operative management. Ninety-four children (21.5 per cent) treated by initial non-operative management required appendicectomy during the index hospital admission while recurrent appendicitis after discharge occurred in 25 (10.4 per cent) children within 1 year. The overall success rate of non-operative management at 1 year was 63.1 per cent (95 per cent c.i. 58.0 to 68.3 per cent). For propensity-score matched analyses, 688 children undergoing surgery and 307 undergoing non-operative management were included. Any predefined complication occurred in 50 (7.3 per cent) children undergoing surgery and in four (1.3 per cent) children undergoing non-operative management (OR 5.9 (95 per cent c.i. 2.1 to 16.6)) in the propensity-score matched cohort. There was no mortality or stoma formation.

Conclusion: Non-operative management is a safe and valid alternative to appendicectomy in children with uncomplicated appendicitis.





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Accepted/In Press date: 9 April 2023
e-pub ahead of print date: 5 May 2023
Published date: 2 June 2023
Additional Information: Publisher Copyright: © The Author(s) 2023. © The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

Identifiers

Local EPrints ID: 476617
URI: http://eprints.soton.ac.uk/id/eprint/476617
ISSN: 2474-9842
PURE UUID: 82d52bc9-b87f-4418-a8a4-36adda502d7b
ORCID for George Bethell: ORCID iD orcid.org/0000-0002-1302-0735
ORCID for Nigel Hall: ORCID iD orcid.org/0000-0001-8570-9374

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Date deposited: 10 May 2023 16:35
Last modified: 14 Aug 2024 04:01

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Contributors

Author: George Bethell ORCID iD
Author: Clare M Rees
Author: Jonathan Sutcliffe
Author: Nigel Hall ORCID iD
Corporate Author: CASCADE study collaborators

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