Systematic Review and Meta-analysis to Compare the Short- and Long-term Outcomes of Non-operative Management With Early Operative Management of Simple Appendicitis in Children After the COVID-19 Pandemic.

Decker, Emily, Ndzi, Agnes ORCID: 0009-0004-3943-1868, Kenny, Simon and Harwood, Rachel ORCID: 0000-0003-3440-3142 (2023) Systematic Review and Meta-analysis to Compare the Short- and Long-term Outcomes of Non-operative Management With Early Operative Management of Simple Appendicitis in Children After the COVID-19 Pandemic. Journal of pediatric surgery. S0022-3468(23)00762-5-.

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Official URL: http://dx.doi.org/10.1016/j.jpedsurg.2023.12.021

Abstract

<h4>Background</h4>Non-operative management (NOM) of simple appendicitis is becoming an increasingly researched treatment option. This systematic review aims to describe the short and long-term failure rates of NOM and the complication rate of appendicectomy in children with simple appendicitis.<h4>Methods</h4>The systematic review was registered a priori (CRD42022322149). Study inclusion criteria are: participants aged ≤ 18 years of age; groups undergoing both NOM and appendicectomy for simple appendicitis; outcomes including one or more of: NOM failure rate at 30 days or 1 year and beyond; study design: RCT or case control study. Four databases were searched and 3 reviewers determined study eligibility and data extraction. Risk of bias was assessed and meta-analysis was performed using Stata.<h4>Results</h4>The database search identified 2731 articles, 14 studies met the inclusion criteria; 4 RCTs and 10 case controlled studies. All studies had moderate-serious risk of bias. There were no deaths in either group in any study. Meta-analysis demonstrated a 30 day failure rate of 20 % (95 % CI 11-29 %) and 11 studies reported failure rate at 1 year or beyond at 32 % (95 % CI 25-38 %). Rates of significant complications of appendicectomy was 1 % (95 % CI 0-1 %).<h4>Conclusions</h4>Non-operative management of simple appendicitis in children is safe, with moderate early success. The failure rate increases over time, resulting in eventual appendicectomy in a third of the children diagnosed with appendicitis. These data will enable clinicians to have an informed discussion with children and their parents about their treatment options for simple appendicitis.<h4>Level of evidence</h4>II.

Item Type:	Article
Uncontrolled Keywords:	Appendicitis, Conservative, Non-operative, Paediatric
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	21 Dec 2023 13:44
Last Modified:	26 Feb 2024 18:09
DOI:	10.1016/j.jpedsurg.2023.12.021
Open Access URL:	https://doi.org/10.1016/j.jpedsurg.2023.12.021
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3177587