FOR IMMEDIATE RELEASE  

To contact Martin L. Blakely, MD, MS:

Call Dena L. Owens at 901-448-4072 or e-mail: dowens10@uthsc.edu


Surgery Sooner Rather Than Later Better for Children with Perforated
Appendicitis

CHICAGO -- For children with a perforated appendix, early appendectomy
appears to reduce the time away from normal activities and has fewer
adverse events as compared to another common option, the interval
appendectomy, which is performed several weeks after diagnosis,
according to a report published online first in the Archives of Surgery,
one of the JAMA/Archives journals. The paper will appear in the June
2011 print issue of the journal.

"Appendicitis is the most common gastrointestinal condition that
requires urgent surgical treatment in children in the United States,"
according to background information provided by the authors. About 30
percent of the cases are perforated appendicitis. For acute,
nonperforated appendicitis, the universally accepted treatment is urgent
appendectomy. But, for children with perforated appendicitis, there are
two commonly used surgical treatment options: early appendectomy, in
which the patient undergoes surgery within the first 24 hours of
hospitalization, and interval appendectomy, in which the surgical
removal of the appendix is planned for 6 to 8 weeks after the initial
diagnosis and the patient has left the hospital and returned to normal
activities. The authors note the potential advantage of the interval
appendectomy is to perform the operation when contamination in the
abdominal cavity has resolved, potentially resulting in fewer surgical
complications.

To compare the effectiveness and adverse event rates of early versus
interval appendectomy, Martin L. Blakely, M.D., M.S., from the University of
Tennessee Health Science Center, Memphis, Tenn., and colleagues
evaluated the surgical outcomes of 131 patients under the age of 18 who
had a preoperative diagnosis of perforated appendicitis between October
2006 and August 2009. The patients were randomized into two groups: 64
were in the early appendectomy group and 67 were in the interval
appendectomy group.  The researchers used time away from normal
activities and overall adverse event rates (such as, intra-abdominal
abscess, surgical site infection, unplanned readmission) as the main
outcome measures.

"Early appendectomy, compared with interval appendectomy, significantly
reduced the time away from normal activities (average, 13.8 vs. 19.4
days)," the authors report. The overall adverse event rate was 30
percent compared to 55 percent for early versus interval appendectomy.
The total length of hospital stay was also reduced by an average of more
than two days for patients receiving the early appendectomy compared to
those who received the interval appendectomy. Some of the patients in
the interval group (23 patients or 34 percent) had an appendectomy
earlier than planned because of failure to improve (17 patients),
recurrent appendicitis (five patients), and other reasons (one patient).

"We found that those treated with early appendectomy return to normal
activities an average of five days earlier. Because a child's time away
from normal activities limits parents' abilities to work, we believe it
is an important outcome from a patient and family perspective," the
authors remark. "The overall adverse event rate after early appendectomy
was significantly lower compared with interval appendectomy," the
authors conclude.

(Arch Surg. doi.10.1001/archsurg.2011.6. Available pre-embargo to the
media at www.jamamedia.org <http://www.jamamedia.org/>)


Editor's Note: This study was supported by a LeBonheur Children's
Hospital grant and funding from the Accredo Health Foundation.
Please see the article for additional information, including other
authors, author contributions and affiliations, financial disclosures,
funding and support, etc.   

###