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- Treating uncomplicated pediatric appendicitis with antibiotics is cost-effective and safe.
- A study analyzed over 1,000 cases, showing antibiotics cost $8,044 versus $9,791 for surgery.
- Researchers plan further studies but note limitations like regional data and short follow-up.
SALT LAKE CITY — Treating children who have uncomplicated acute appendicitis only with antibiotics is both cost-effective and safe compared to having surgery, according to a study published in the Journal of the American College of Surgeons.
The National Institutes of Health reports that appendicitis is the fifth most common reason that children are hospitalized and an appendectomy is the most common procedure performed on children when they are in the hospital. Previous studies have shown that treating uncomplicated cases of appendicitis solely with antibiotics is safe.
The new study set out to see if it's also cost-effective since the surgery to remove the appendix is one of the most costly procedures performed during children's hospital stays.
Antibiotics had already proven effective in treating uncomplicated appendicitis, said Dr. Peter C. Minneci, who leads the surgery department at Nemours Children's Hospital in Wilmington, Delaware, and co-wrote the study, in a written statement. "This cost analysis demonstrates that nonoperative management for pediatric uncomplicated acute appendicitis is the most cost-effective strategy over one year, compared to upfront surgery."
Surgery vs. antibiotics
To check costs, researchers analyzed data from more than 1,000 young patients, ages 7 to 17, admitted for acute appendicitis to hospitals throughout the Midwest between 2015 and 2018. None of their cases were complicated.
Parents chose whether their children received antibiotics for at least 24 hours or surgery. In cases where antibiotics were not effective, laparoscopic appendectomy was done during the same hospital stay.
The study compared costs by dividing the cost by the charges for the hospitalization, readmissions and unplanned emergency room visits using data from the Public Health Information System. According to the release, it captured data from about 50 children's hospitals.
Researchers collected patient-reported data on time off from school and pain at 30 days and a year after treatment. Quality of life data was also converted to data points. Ultimately, on a scale from zero (death) to one (perfect health) with everything else in between, they determined both the safety and cost-effectiveness of treating with antibiotics alone.
Of 1,068 patients, 370 were treated with antibiotics while 698 had laparoscopic appendectomy.
The average cost was $9,791 and a 0.884 quality-adjusted life year score per patient with surgery, compared to $8,044 and 0.895 quality-adjusted life year per patient for those with antibiotics alone.
The researchers have further studies planned, including what happens with same-day discharge in both treatment populations.
They did note limitations, including the short follow-up period — just a year — and the fact they just looked at cases in the Midwest, so it might not be applicable to the entire country.
