Initial Antibiotics and Delayed Appendectomy for Acute Appendicitis

Several recent studies have examined the feasibility and benefits of nonoperative treatment
of perforated appendicitis in children. One such study showed a trend toward longer
operative times for patients randomized to immediate appendectomy, but no overall advantage.
In another larger study, the costs of delayed appendectomy for perforated appendicitis were
higher - in part related to readmissions in the interval (6-8 weeks). Nevertheless, these
and other studies have demonstrated the safety of delaying appendectomy for perforated
appendicitis.

Emergency appendectomy is a well-established approach, and postoperative recovery in
children is fast. Nevertheless, from the onset of symptoms through the hospital stay and the
postoperative recovery, appendicitis causes a disruption of a family's normal routine
(absence from school and work) of up to 1-2 weeks. Because this is an unplanned operation,
patients have to wait until an operating room becomes available, or elective operations have
to be placed on hold to accommodate the emergency operation. Each year, more than 250
children undergo an appendectomy at HCH. This represents 250 episodes of emergency surgery,
or about one emergency add-on operation per working day. If an initial trial of antibiotics
is safe for the treatment of appendicitis, converting an emergency operation into an
elective, scheduled outpatient procedure may reduce stress and disruption of routine for
patients and their families - and may allow better operating room planning for health care
professionals and hospitals.

The investigators hypothesize that initial antibiotic treatment of acute (non-perforated)
appendicitis, followed by scheduled outpatient appendectomy, reduces the overall cost of
treating the disease and results in greater patient and family satisfaction.

This pilot study aims to establish the safety and feasibility of treating acute appendicitis
with intravenous antibiotics, followed by outpatient oral antibiotics. Patients and their
families will be offered the possibility of initial nonoperative treatment and subsequent
outpatient elective appendectomy in a nonrandomized, single arm study.