By Inflame 
Appendicitis is a common reason for hospitalization among children, and surgery (appendectomy) has traditionally been the go-to treatment. However, new research suggests that for uncomplicated cases, antibiotics alone could be a safe, effective, and more affordable alternative.
A study published in the Journal of the American College of Surgeons (JACS) sheds light on how nonoperative management—using intravenous antibiotics without surgery—compares to urgent laparoscopic appendectomy in terms of cost and health outcomes.
What Does the Study Say?
The research analyzed data from 1,068 children aged 7–17 who were treated for uncomplicated acute appendicitis at hospitals across the Midwest between 2015 and 2018. Parents were given a choice:
- Antibiotics-Only Treatment: At least 24 hours of intravenous antibiotics, with surgery reserved for cases where symptoms didn’t resolve.
- Urgent Laparoscopic Surgery: A minimally invasive procedure performed during the same hospital admission.
Key Findings
- Cost:
- Surgery: Average cost of $9,791 per patient.
- Antibiotics: Average cost of $8,044 per patient—around 18% cheaper.
- Health Outcomes:
- Quality of life one year after treatment was slightly better for kids treated with antibiotics.
- Disability days (time off from school or normal activities) were lower for the antibiotics group.
The study used a “quality-adjusted life year” (QALY) scale to measure health outcomes, where 1 indicates perfect health. The QALY score for antibiotics was 0.895, slightly higher than 0.884 for surgery.
Why Does It Matter?
Nonoperative management offers significant savings without compromising safety or effectiveness. “This cost analysis demonstrates that nonoperative management for pediatric uncomplicated acute appendicitis is the most cost-effective strategy over one year,” said Dr. Peter C. Minneci, co-author of the study.
Parents might also prefer antibiotics for fewer disruptions to daily life, reduced hospital stays, and lower overall costs.
What’s Next?
Researchers plan to explore:
- Long-term outcomes of antibiotics vs. surgery.
- The effectiveness of outpatient antibiotic treatment.
- Same-day discharge options for laparoscopic appendectomy.
Limitations
The study only included patients treated at children’s hospitals in the Midwest and followed them for one year. Results might vary in other regions or over a longer period.
Takeaway
For uncomplicated appendicitis, antibiotics offer a safe and cost-effective alternative to surgery, making it a viable option for parents to consider. However, it’s essential to consult with healthcare providers to determine the best approach for each child.
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