Early appendectomy vs. conservative management in complicated acute appendicitis in children: A meta-analysis.
Abscess
Children
Complicated
Complicated appendicitis
Conservative
Non-operative management
Pediatric
Perforated appendicitis
Journal
Journal of pediatric surgery
ISSN: 1531-5037
Titre abrégé: J Pediatr Surg
Pays: United States
ID NLM: 0052631
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
17
12
2018
revised:
29
01
2019
accepted:
29
01
2019
pubmed:
13
3
2019
medline:
29
2
2020
entrez:
13
3
2019
Statut:
ppublish
Résumé
No consensus exists among surgeons regarding the optimal treatment of complicated acute appendicitis in children (CAA). Existing studies present heterogeneity of data and only few studies analyzed free perforated appendicitis (FPA) separately from appendicular abscess (AAb) and appendicular phlegmon (AP). Studies which have been judged eligible for this systematic review and consequent meta-analysis are those comparing non-operative management (NOM) with operative management (OM) in children with CAA. Studies were subgrouped between those analyzing mixed patients with CAA, those focusing on patients with AAb/AP and those focusing on patients with FPA. Fourteen studies fulfilled the inclusion criteria and were included in the meta-analysis with a total of 1288 patients. In the fixed-effects model the complication rate was significantly favorable to the initial NOM arm for the AAb/AP subgroup (RR = 0.07, 95%CI = 0.02-0.27) and to the OM arm for the FPA subgroup (RR = 1.86, 95%CI = 1.20-2.87); the re-admission rate was significantly favorable to the initial NOM arm for the AAb/AP subgroup (RR = 0.35, 95%CI = 0.13-0.93) and to the OM arm for the FPA subgroup (RR = 1.49, 95%CI = 1.49-7.44). There was no statistical heterogeneity for the two subgroups of patients. The costs weren't significantly different between NOM and OM. The length of stay was favorable to OM. The pooled proportion rate of NOM success was 90%, the pooled relapse rate of appendicitis was 15.4%. Children with AAb/AP reported better results in terms of complication rate and re-admission rate if treated with NOM. Conversely children with FPA showed lower complication rate and re-admission rate if treated with OM. II.
Sections du résumé
BACKGROUND
BACKGROUND
No consensus exists among surgeons regarding the optimal treatment of complicated acute appendicitis in children (CAA). Existing studies present heterogeneity of data and only few studies analyzed free perforated appendicitis (FPA) separately from appendicular abscess (AAb) and appendicular phlegmon (AP).
METHOD
METHODS
Studies which have been judged eligible for this systematic review and consequent meta-analysis are those comparing non-operative management (NOM) with operative management (OM) in children with CAA. Studies were subgrouped between those analyzing mixed patients with CAA, those focusing on patients with AAb/AP and those focusing on patients with FPA.
RESULTS
RESULTS
Fourteen studies fulfilled the inclusion criteria and were included in the meta-analysis with a total of 1288 patients. In the fixed-effects model the complication rate was significantly favorable to the initial NOM arm for the AAb/AP subgroup (RR = 0.07, 95%CI = 0.02-0.27) and to the OM arm for the FPA subgroup (RR = 1.86, 95%CI = 1.20-2.87); the re-admission rate was significantly favorable to the initial NOM arm for the AAb/AP subgroup (RR = 0.35, 95%CI = 0.13-0.93) and to the OM arm for the FPA subgroup (RR = 1.49, 95%CI = 1.49-7.44). There was no statistical heterogeneity for the two subgroups of patients. The costs weren't significantly different between NOM and OM. The length of stay was favorable to OM. The pooled proportion rate of NOM success was 90%, the pooled relapse rate of appendicitis was 15.4%.
CONCLUSIONS
CONCLUSIONS
Children with AAb/AP reported better results in terms of complication rate and re-admission rate if treated with NOM. Conversely children with FPA showed lower complication rate and re-admission rate if treated with OM.
LEVEL OF EVIDENCE
METHODS
II.
Identifiants
pubmed: 30857730
pii: S0022-3468(19)30125-3
doi: 10.1016/j.jpedsurg.2019.01.065
pii:
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2234-2241Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.