Early Appendectomy Favored in Youths

Those who have surgery weeks after appendix rupture spend more time away from activities

THURSDAY, Feb. 24 (HealthDay News) -- Children with perforated appendicitis who undergo an appendectomy within 24 hours of hospital admission spend significantly less time away from normal activities and experience fewer adverse events compared to those who undergo removal six to eight weeks after diagnosis, according to a study published online Feb. 21 in the Archives of Surgery.

Martin L. Blakely, M.D., of the University of Tennessee Health Science Center in Memphis, and colleagues compared the effectiveness of early and interval appendectomy in children younger than 18 with clinically diagnosed perforated appendicitis. A total of 131 children with a preoperative diagnosis of perforated appendicitis were randomized to undergo an appendectomy either within 24 hours of admission or six to eight weeks after diagnosis. The main outcomes measured were the number of days away from normal activities and the rates of overall adverse events and predetermined specific adverse events.

The researchers found that children who underwent an early appendectomy were away from their normal activities for significantly less time (mean, 13.8 days) compared to those who underwent a later appendectomy (mean, 19.4 days). The overall adverse event rate for early appendectomy was 30 percent, compared to 55 percent for the interval appendectomy. Among the patients who were randomized to have later surgery, 34 percent required an appendectomy earlier than planned, mainly because of failure to improve or recurrent appendicitis.

"This trial represents the only randomized trial comparing early and interval appendectomy in nonselected children with a preoperative diagnosis of perforated appendicitis and definitively favors early appendectomy," the authors write.

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