Nonoperative treatment emerging for pediatric appendicitis

At the 2024 American Academy of Pediatrics National Conference & Exhibition, Steven Selbst, MD, professor of pediatrics at Nemours Children’s Health and Sidney Kimmel Medical College, highlighted the growing trend toward nonoperative management of appendicitis in children.

Traditionally, children diagnosed with appendicitis would undergo surgery immediately. However, Selbst emphasized that new studies support the option of treating appendicitis with antibiotics rather than surgery in many cases.

Transcript (edited for clarity):

Steven Selbst, MD:

"I think there's a recent trend that somewhat involves emergency medicine, for nonoperative management of appendicitis. In the past, it always was a standard that child came in with appendicitis, they were going to have an appendectomy that day. But now, we call our surgeons, and they come down and have a conversation with the family to see if they're interested in nonoperative management.

There are studies out there that show that about half the children can get by with antibiotics and medical management and observation and don't need surgery, even after they've been followed for 21 months. At 21 months, 76% of the kids didn't need an operation. Five years out, half the kids didn't need an operation. So on the one hand, it's a simple operation, laparoscopic appendectomy, but on the other hand, you can get away without any surgery in many of the cases.

So this has become a trend now to consider nonoperative management of appendectomy. It's definitely a cost saving. The child doesn't need to be admitted to the hospital.

There's definitely savings and cost to the patient and to our insurance companies, to our medical societies in general."